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Rejuvenation of the upper part of the face is not included in a facelift and is an often overlooked and important procedure in overall rejuvenation of the face. There are several names used for this procedure, and each forehead surgery is individually tailored to the patient. Usually done when eyelid surgery is contemplated, this operation really adds a "WOW" factor to refreshening the look of the eyes and upper face.
Over time and with gravity the upper face drops, and the brow may drop below the bony rim that houses the eye. This tends to increase the overhang of the upper eyelid skin, and obstruct vision in the upper fields of gaze. To compensate, we begin to walk around unconsciously raising our eyebrows, creating deep muscle wrinkles horizontally across the forehead. Try standing in front of a mirror and forcing your brows to relax, manually if need be. Most people find their brows are lower than they think.
The brow or forehead procedure can be done in several ways, endoscopically through small scalp incisions, or in a coronal approach which goes across the scalp if more exposure is needed to get the job done, however in both ways the scar is in the hair. In balding men, the endoscopic appraoch is preferable. Some drop of the lift after surgery is almost always seen, even in the first few months, and the amount of drop over time cannot be predicted. In order to improve the longevity it is sometimes necessary to use a support, generally in the form of an absorbable claw-like fastener or "endotine" that sits on the bone and holds the lift until healing occurs.
Forehead and brow surgery can also address the dynamic muscle wrinkles of the forehead and frown lines and lessen them, although some regrowth may occur over time and some patients still use Botox, usually to a lesser degree than before forehead surgery.
Forehead lift can be done with or without eyelid surgery and midface lift, and with or without facelift. Your surgeon will tailor the recommendadtion acording to the way your face is aging, and ulimately what you choose is up to you.
