The effects of aging are inevitable, and, often, the brow and forehead area show the first signs. The skin begins to lose its elasticity. Sun, wind, and the pull of gravity all affect the face, resulting in frown lines, wrinkling across the forehead, and an increasing heaviness of the eyebrows. Even people in their thirties may have faces that look older than their years. Your tired, angry, or sad expression may not reflect how you actually feel. As a result, many people have opted for a procedure known as the forehead lift. Based on variations in how men and women age and on new advances in medical technology, different methods are used to perform this procedure. If you are wondering how a forehead lift could improve your appearance, you need to know how these procedures are performed and what you can expect. This pamphlet can address many of your concerns and provide you the information you need to begin considering forehead surgery. Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Your surgeon can answer specific questions about your specific needs. As with all elective surgery, good health and realistic expectations are prerequisites. When a surgeon tightens loose skin and removes the excess, forehead wrinkling and drooping brows are modified. The procedure is called a forehead lift or brow lift. If necessary, the surgeon removes part of the muscle that causes vertical frown lines between the brows. The result can be a smoother brow and a more youthful expression. To see what a forehead lift can do for your face, put your hands above your brows and outside the edges of your eyes and gently raise the skin upwards. Forehead lifts are an option if you have a sagging brow or deep furrows between the eyes. This procedure is usually done between age forty and sixty-five, although it may be necessary at an earlier age. Incisions can be placed at the hairline, behind the hairline, or in some cases, above the brow or in the mid-forehead. Your surgeon can help you select the best technique suited to your particular situation. Whether you are having surgery for functional or cosmetic reasons, your choice of a qualified facial plastic surgeon is of paramount importance. During the consultation, the surgeon will examine your facial structure, the condition of your skin, and your hairline in order to decide where incisions should be made. A thorough medical history will be obtained so that your surgeon can consider any medical conditions that may heighten surgical risks. A detailed description of the procedure will also include a discussion of risk involved. After the decision to proceed with surgery is made, the surgeon will describe the technique indicated, the type of anesthesia, the surgical facility, any additional surgery, and the risks and costs. The main difference among the various options for forehead lifting consists of the placement of the incision. The original technique is the coronal incision, which is made slightly behind the natural hairline. An alternative is the pre-trichial incision. This is similar to the coronal incision except that the mid-portion of the incision is made directly at the hairline. This incision generally heals favorably and has the advantage of lowering the hairline. The disadvantage could be noticeable scarring. An option is to place the incision within the midforehead creases. This is primarily used in men with deep pre-existing forehead lines. The newest apporach is endoscopic surgery. Several small one-half-inch to one-inch incisions are placed just behind the hairline. Althought this technique may require more surgery time, it is less invasive and results in a smaller chance of temporary scalp numbness. This procedure takes between one to two hours to perform. It is most commonly performed under IV sedation or twilight anesthesia. You will experience a certain amount of swelling and bruising in the 10-day period following surgery. In some patients, this condition may include the cheek and eye area as well as the forehead. You will be advised to keep your head elevated in order to reduce swelling. Cold compresses may further reduce swelling. As the incisions heal, you may experience some numbness as well as itching, both of which will diminish with time. The sutures are usually removed within seven to 10 days following surgery. If bandages have been used, they are removed in one to three days. It is important to follow the advice of your surgeon on resuming normal activities. For most patients, the recovery time will not exceed two weeks, but patients may still be advised to avoid strenuous activities for longer periods. Any prolonged bruising can be camouflaged with standard make-up techniques. Not infrequently, a brow lift is combined with Blepharoplasty (an eyelid tuck) or face lift to provide a harmonious rejuvenation. Facial plastic surgery makes it possible to correct many facial flaws and signs of premature aging that can undermine self-confidence. By changing how you look, cosmetic surgery can help change how you feel about yourself. Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve sagging foreheads and brows which interfere with vision may be reimbursable in whole or in part. It is the patient's responsibility to check with the insurance carrier for information on the degree of coverage. This section © Copyright 2000 American Academy of Facial and Reconstructive Plastic Surgery