Lidlift Keneth D. Steinsapir, M.D.
Cosmetic, Facial & Eye Plastic Surgery

As detailed in the section on eyelid surgery, the position of the eyebrow is determined by a tug of war between the elevating muscles in the forehead and the muscles along and just below the eyebrow that pull the eyebrow down. When the upper eyelid fold encroaches into the upper eyelid space, the fold can rest on the eyelid platform, the eyelashes, or partially block the upper aspect of the visual field. Each of theses encroachments stimulates the brain to send a motor signal to the elevator muscle of the forehead, the frontailis muscle, to lift. This action serves to elevate the eyebrow reducing eyelid space encroachment. This motor activity accounts for lines or rhytids on the forehead. Understanding this relationship is a reoccurring theme on this website. It is critical for understanding how to perform an ideal BOTOX® treatment, and when to perform eyelid surgery or a forehead lift.

Droopy Eyebrows

For many people with a heavy eyebrow, the forehead lift is the ideal approach. This surgery repositions the brow tissue at a higher level. In some cases the brow was always relatively low but for others the eyebrow ptosis develops over time. The goal of the surgery is to provide a repositioning of the eyebrow in a higher location without a hint of the surprised look. Think of the surgery as a way of placing the eyebrow at an elevated position such that the forehead muscle are essentially at rest. This means an elevated forehead but also a smooth forehead.

Small Incision Forehead Surgery

Since 1990, forehead surgery has undergone a small incision revolution. Prior to this time, forehead lifts were done “open.” This is surgical speak for making a cut in the top of the scalp from one ear to the other, the so-called coronal lift. This is sometimes referred to as the “Beverly Hills” haircut. Rightly so, potential patients were frightened by this surgery, which gave them the impression that their surgeon was planning on “scalping” them. The surgery was highly effective at raising the forehead but had some all too common and unwanted side effects. First, the surgery required a very long incision that cut sensory nerves to the top of the head and created persistent numbness. The long incision placed a great deal of tension along the incision and was associated with unsightly hair loss along the incision in some. Easy access to the muscles of facial expression under the forehead flap lead to over resection of these muscles with permanent and unnatural paralysis of forehead muscles. Recover time was about 6 weeks before the swelling of the surgery was sufficiently diminished that others would not notice or ask about the effects. Despite these significant side effects, the open forehead lift was a popular and important surgery in its day, but that day is now long over.

Endoscopic Forehead Lift

The open coronal forehead lift has been largely replaced with the small incision endoscopic forehead lift. This has been a revolutionary advance for many reasons. First, smaller incision surgery means less healing and a faster recovery. The procedure is associated with few complications compared to the open technique. Numbness of the scalp, which was universal with the open forehead lift, is rare with the endoscopic forehead lift. There is very little if any hair loss with a small incision forehead lift. Men were not good candidates for the open forehead lift because of the male pattern hair loss. This meant that even if a man had enough hair at the time of surgery to hide the incision, there was no guarantee that the scar would stay hidden in the future. With the small incision forehead lift, it is routine to do these surgeries on bald or balding men and the scars are virtually undetectable. The initial criticism of the endoscopic forehead lift was that the procedure did not last. However, with now almost 20 years of follow-up on these procedures, it is clear that the endoscopic forehead lift holds up as well as the open forehead lift.

Forehead Lift Needs

At the time of consultation, Dr. Steinsapir will assess you and your goals. He will determine if you are in fact a good candidate for a forehead lift. The issue is what type of eyebrow support and shape you need. Some individuals need just a forehead lift. He will assesses if something needs to be done to address upper eyelid issues. Some people will have both eyebrow ptosis and excess upper eyelid skin and fullness and benefit from both sets of issues being addressed at the same time. Surgery itself is typically done at the UCLA outpatient surgery center where Dr. Steinsapir is on staff as an Associate Clinical Professor and Attending Surgeon. The procedure requires intravenous sedation but general anesthesia is typically not needed. This means that you have surgery with minimal drug exposure contributing to a faster recovery. Swelling and bruising can last for several weeks. However, most women find that after 7 to 10 days and with a little make up, they can go out and about without calling attention to themselves. Most men find they can return to their work routine with out make up at 7 to 10 days.

Forehead Lift Recovery

To support the forehead while the body heals, there are several options for brow fixation. The two most common options in this practice are the Coapt endobrow tine or microscrew fixation. The Coapt device is a small plate that is used in pairs. The plate is fixed to the forehead bone and supports the forehead. The device is completely covered and over time will completely dissolve. Occasionally it will produce a small bump that you can feel but generally this is hidden in the hair and does not present an issue. I have had several patients with some tenderness related to the device. This resolved on all of them except for a couple of individuals for whom I removed the device in the office three months after surgery. The other method for supporting the forehead after surgery involves three small microscrews that poke out of the scalp. A small staple behind each post supports the forehead. The posts and the staples are removed about three weeks after surgery. Again, these are hidden in the hair and are generally not noticeable to others.