Forehead and Brow Lift | Doctors & Treatment Information

As we age, the tension in the forehead and the activity of the facial muscles decrease. This leads to deeper horizontal wrinkles in the forehead area. Examples include frown lines (vertical wrinkles between the eyebrows) and crow’s feet (wrinkles at the corners of the eyes).

At the same time, the eyebrows and eyelids droop. However, this is not drooping eyelids, but rather a misalignment of the eyelids.

Therefore, even a lift to correct age-related drooping of the upper eyelid cannot eliminate the problem of eyes that appear tired, negative, or rather sad.

This requires a procedure that lifts both the forehead and the eyebrow area through surgery. The appropriate procedure is called a forehead-brow lift.

An incision along the hairline (hairline cut) detaches the forehead skin from the underlying muscles. The surgeon then repositions the eyebrows, thereby correcting their drooping. This tightens the forehead.

The procedure can be extended to lift sagging cheek areas, a technique known as an “upper face lift.”

The surgery preserves skin sensitivity and natural facial expressions. To avoid unnatural, “operated-looking” facial features, the surgeon must have a keen sense of aesthetics. It is also important that the surgeon adapts the procedure to the patient’s individual anatomical characteristics.

Compared to alternative methods, the forehead-brow lift is the procedure that is gentler on the nerves and carries a lower risk of complications. The surgeon has greater flexibility in repositioning the eyebrows. An advantage of the forehead-brow lift with a hairline incision is that it leaves no visible scars in the eyebrow area.

Age-related facial changes often create a tired appearance.

These include:

• Sagging eyebrows
• Smaller-looking eyes
• Wrinkles and fine lines

The aesthetic aspect is therefore the main reason why people undergo a forehead-brow lift. According to experts, after the surgery, facial expressions appear more youthful, dynamic, and fresh. The procedure does not result in unnatural-looking facial features.

The goals of the surgery are:

• Elimination of age-related facial wrinkles (crow’s feet, frown lines, horizontal wrinkles)
• Elimination of drooping eyelids (pseudoblepharochalasis)
• Lifting the eyebrow area, which has typically sagged laterally
• If necessary, reducing (or increasing) the height of the forehead and correcting any receding hairline
• Correction of sagging cheeks

Crow’s feet can be eliminated with a forehead-brow lift @ Lustre /AdobeStock

The procedure is performed on both women and men. In men with hair loss, the scar may be visible.

In this case, doctors can conceal the scar using a micro-transplantation of the patient’s own hair. Micro-hair transplantation can also rejuvenate the faces of men who have a high forehead or receding hairline.

Autologous hair microtransplantation helps men conceal their scars @ Cavan /AdobeStock

A scientific study has shown that facial rejuvenation also results in positive changes as perceived by others.

On average, study participants estimated that people who had undergone facial rejuvenation looked four years younger. They also received more positive ratings in terms of attractiveness, health, and self-confidence.

If the drooping eyelids are caused by ptosis, a forehead-eyebrow lift is not suitable. In such cases, the surgeon must remove the excess eyelid skin and correct the protruding fatty tissue as well as the weakened eyelid muscle.

Individuals with an increased surgical risk should only consider this procedure after a thorough examination and after weighing the pros and cons.

Before the surgery, a general practitioner should conduct a thorough examination (including blood tests, blood pressure measurement, and an ECG).

To reduce the risk of complications, patients must stop taking blood-thinning medications (such as aspirin) three weeks before surgery.

The patient should stop smoking four weeks before the surgery.

The surgical procedure:

1. The surgery is performed under analgosedation (pain relief with medication and light sedation). The patient is not intubated but breathes independently.
2. The surgeon then makes an incision at the hairline. In rare cases, the incision is made within the hair. Thanks to this minimally invasive incision, the scars are not visible afterward.
3. In contrast, a direct brow lift leaves clearly visible scars, as the incision is made directly above the eyebrow.
4. First, the doctor detaches the muscle attachment from the forehead skin. He then repositions the eyebrows and tightens the forehead without altering the hairline. 
5. Since these muscles are not completely severed or removed, a natural appearance is preserved. Additionally, the doctor can shape the eyebrows into any desired form and position.
6. After the surgery, the doctor sutures the incision and applies a special head bandage, which the patient wears for a few days.

Typically, the patient can wash their hair again one day after the surgery.

They can also leave the clinic one day later.

The wound is checked and the stitches are removed on an outpatient basis on the tenth day.

Normal daily activities are usually possible after seven to 14 days.

For four to six weeks, the patient must not dye their hair or get a perm. 

They should also avoid sports, sunbathing, and sauna visits during this time.

• After the surgery, the change usually feels unfamiliar. Head movement and facial expressions may be limited. 
• Mild numbness in the forehead and pain may also occur. 
• Initial swelling and bruising are common in older patients. 
• If the surgery is not performed correctly, there is a risk of nerve damage. The consequences can include permanent sensory disturbances or numbness. 
• Furthermore, in rare cases, the procedure can lead to postoperative bleeding, circulatory problems, and infections. 
• A non-infectious disruption of wound healing (wound margin necrosis) can also occur, but this is rare. If it does occur, it is typically in patients with pre-existing conditions (heavy smokers and diabetics).
• Occasionally, unsightly and visible scars may develop that do not improve even with scar revision. A micrograft of the patient’s own hair helps to conceal the scars within the hair.

The effects of the procedure improve over the course of the first few days and usually disappear after ten to 14 days.

Overall, the forehead-eyebrow lift is a plastic and aesthetic surgical procedure with a low risk of complications. 

When properly indicated, planned, and performed, it can lead to positive long-term aesthetic results. However, the rejuvenating effect is not permanent, as the aging process continues. A subsequent lift is possible.