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About Face

Chapter Three The Eye Region Upper and Lower Lid Surgery Forehead-lift The Single Lid (Oriental Eye) Permanent Lash Enhancement

Forehead-lift

To do a forehead-lift, I make an incision in an arc roughly where a girl might wear a plastic hairband. It begins just above each ear and meets at a point at the top of the head, slightly behind the hairline to hide the long, find scar that will result. In the case of a patient with a high forehead, the trick is to make the incision exactly along the hairline, at the junction of the hair and the forehead. This prevents that hairline from “migrating” back even further. If I am operating on a man, and he had male-pattern baldness extending well back of his scalp, the process is slightly different. I might, for example, hide the scar in an existing line on his forehead. (For more information, see Chapter Ten: Hair Transplants.)

The skin of the scalp is loosened away from the bone underneath - it actually comes away quite easily with a combination of a few scissors snips and finger manipulation - so that I can literally “pull up” the forehead to restore the position of the brows. Before pulling up, I can weaken the corrugator muscle that is responsible for deep frown lines between the eyebrows. Excess skin is cut away before closing the seam of the incision with sutures, and the operation is over, usually within an hour and a half.

As simple as it sounds, the forehead-lift is a delicate procedure because you’re dealing with the big band of frontalis muscle that stretches from side to side across the forehead; the muscle that causes horizontal wrinkle lines. This muscle may have to be weakened. As well, there are the all-important frontal branches of the facial nerve that run up the sides of the face through the temple areas. These branches allow you to lift your brow into one of the many human expressions of surprise or joy or sorrow. A surgeon must be careful not to damage these nerves.

The happy result of a successful forehead-lift is that a patient’s eyes look larger and brighter, primarily because they lose some of the sagging skin in the upper lid area caused by the low brow, and the eyebrows are returned to their natural position. In some cases, a patient will have come to me thinking they needed a bleupharoplasty, plastic surgery of the eye, when the sagging could be corrected with a forehead-lift. However, the majority of patients need both operations.

There are a couple of other procedures related to the eye that are worth brief mention. Both are gaining in popularity, and many facial cosmetic surgeons now routinely offer these procedures as part of their service.

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