A forehead lift is a cosmetic procedure done to

• correct sagging of the forehead skin, eyebrows, and upper eyelids and
• improve the horizontal lines and furrows,

in order to restore a more youthful and harmonious appearance.

A forehead lift is done for the following reasons

• to minimise the visible effects of ageing
• to correct furrows or horizontal lines occurring as a result of stress or muscle activity
• to correct inherited conditions, such as a low, heavy brow or furrowed lines above the nose

• Candidates who have had previous plastic surgery to lift eyelids
• Candidates without medical conditions such as
• Uncontrolled high blood pressure
• Blood clotting problems
• Candidates whose forehead has begun to sag, but whose skin still has some elasticity along with strong and well-defined bone structure.
• Candidates in their forties to sixties
• Candidates with inherited conditions requiring a forehead lift
• Candidates who are physically healthy, psychologically healthy and have realistic expectations from the procedure
• Candidates who seek improvement rather than perfection

Though complications occur in very rare cases, they may include

• Formation of a haematoma characterized by pain or swelling affecting one side of the forehead but not the other, in which case the patient may have to return to have the stitches reopened to find the source of the bleeding.
• Injury to the nerves that control eyebrow movement affecting the patient's ability to raise an eyebrow or wrinkle the forehead. Additional surgery may be required to correct the problem.
• Infection
• Formation of a broad scar which may be treated surgically by removing the wide scar tissue so a new, thinner scar may result.
• Hair loss may occur along the scar edges
• Permanent or temporary loss of sensation along or just beyond the incision line is common, especially with the classic forehead lift procedure.
• Infection and bleeding
• Reactions to the anaesthesia
• Poor healing of the skin, mostly seen in smokers.
• Dryness or irritation in the eye

• During the initial consultation, the expectations of the patient are understood
• The surgeon will evaluate the face, including the skin and underlying bone
• The surgeon shall perform a medical evaluation to rule out factors that may affect the procedure such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars.
• Photographs are taken for further comparison after procedure.
• The doctor discusses and advises on options of anaesthesia, surgery, type of facilities and cost with the patient.
• The patient must inform doctor of any previous injury or surgery, allergies, infections, smoking habits, recreational drugs and medications being taken.
• The doctor provides guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications. 
• The patient is advised to stop any anti inflammatory drugs for a period before the surgery.
• Steroid injections may be given before the surgery to reduce swelling
• Vitamins may be prescribed to promote healing
• The patients are advised to let the hair grow out before surgery, in order to hide the scars while they heal.
• The patient must arrange for transportation and assistance to leave for home after the surgery.

• The hair will be tied with rubber bands on either side of the incision line and hair growing directly in front of the incision line may be trimmed.
• The patient is given either a local or general anaesthesia before the surgery. If local anaesthesia is to be given, the patient is given a sedative to relax through an intravenous line after which the local anaesthesia is injected to numb the area.
  
  Classic forehead lift

1. Incisions
   • A coronal incision starting at about ear level and running across the top of the forehead and down the other side of the head is made
   • If the hairline is high or receding, the incision may be placed just at the hairline, to avoid adding even more height to the forehead
   •  In patients who are bald or losing hair, a mid-scalp incision that follows the natural pattern of the skull bones is recommended
2. The skin of the forehead is carefully lifted to remove the underlying tissue and to alter the muscles of the forehead.
3. The eyebrows may also be elevated and excess skin at the incision point trimmed away to help create a smoother, more youthful appearance.
   
   The endoscopic forehead lift

• Three to five short scalp incisions are made.
•  An endoscope, a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing the surgeon to have a clear view of the muscles and tissues beneath the skin.
• Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance.
• The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin's surface or by temporary fixation screws placed behind the hairline.
• The incision is then closed with stitches or clips.
• The face and hair will be washed to prevent irritation and the rubber bands will be removed.
• The surgeon may cover the incision with gauze padding and wrap the head in an elastic bandage.
• The operation takes one to two hours to complete.

The surgery is mostly done as an outpatient procedure and the patient is discharged the same day.

• Classic forehead lift
• Patients may experience some numbness and temporary discomfort around the incision, which can be controlled with prescription medication.
• Patients who are prone to headaches may be treated with an additional longer-acting local anaesthesia during surgery as a preventive measure.
• The patient may be advised to keep the head elevated for two to three days following surgery to keep the swelling down.
• Swelling may also affect the cheeks and eyes, which generally disappear in a week or so.
• As the nerves heal, numbness on the top of the scalp may be replaced by itching which may take as long as six months to fully disappear.
• If bandages were used, they will be removed a day or two after surgery.

• Endoscopic forehead lift

• Patients may experience some numbness, incision discomfort and mild swelling which may be alleviated by medications prescribed.
• Incision site pain is usually minimal, but can be controlled with medication, if necessary.
• Itching sensation is usually less compared to the classic forehead lift.
• Within 10 to 14 days, the stitches or clips will be removed in two stages.
• The bandages will be removed a day or two after surgery.
• Some of the hair around the incision may fall out and may temporarily be a bit thinner. Normal growth will usually resume within a few weeks or months.

• The first evening after surgery, the patient must rest quietly with the head elevated.
• The patient will be able to walk around in a day or two, but will not be work-active for at least 7 days after surgery.
• It is permissible to shampoo and shower 2 days after surgery or as soon as the bandages are removed.
• Most patients are back to work or school in 7 to 10 days.
• Vigorous physical activity should be limited for several weeks, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure.
• Contact sports should be avoided for 6 to 8 weeks
• Prolonged exposure to heat or sun should be limited for several months and a sun block must be used to protect the skin.
• The patient must not take aspirin or certain anti-inflammatory medications, and not smoke or be exposed to heavy secondary smoke for a while following surgery.
• Most of the visible signs of surgery should fade completely within 2 to 3 months.

Haematoma - a collection of blood under the skin that must be removed by the surgeon