The forehead is another area where the signs of ageing, such as loosened skin and wrinkles, are visible. Unlike other parts of the face, the process in this area is in its way specific. The skin is attached to the layers underneath much stronger; therefore, with the advancing loss of elasticity the general drop is less significant than in the lower parts of the face. A larger sagging of skin may be seen in the lower area, especially in the area of eyebrows. The formation of mimic wrinkles is related to this stronger attachment to the base. They are rather conspicuous and get deeper with time. Their course is horizontal, slightly waved. Above the root of the nose, there are mimic muscles that cause the movements of the brows. It is here that two or more wrinkles are formed, running vertically, perpendicular to the other horizontal wrinkles of the forehead.
Currently, it is possible to choose from various surgical procedures according to the depth of the wrinkles and the degree of the skin sagging.
When the loosening of the forehead skin and brows is large and the wrinkles rather fixed, a classic surgical technique is preferred. In this surgery, an arch-shaped incision is made from temple to temple just at the hairline. Then the skin is released from the base down to the brows. In the area of the nose root, the mimic muscle fibres that cause the vertical wrinkles between the brows and by the nose root are interrupted so not to deepen the vertical wrinkles between the brows. The skin of the entire forehead is stretched upwards and the excessive pieces are removed – typically 1-2 cm. The arch-shaped scar just above the hairline may pose a problem, particularly for men, since the scar may be rather visible when the hairline begins to recede. That is why this operation is not recommended to men and is carried out on women with remarkable sagging and excessive skin on the forehead.
Another surgical procedure is endoscopic lift carried out with special instruments and a small camera, which enables us to proceed through small incisions about 1 cm long while the camera allows the area that is being operated to be seen on a display. During the endoscopic procedure, usually 4 incisions are made above the hairline – 2 in the middle and 2 above the temples. The stretch and elevation of the skin is done as well, and the excessive skin is spread above the hairline. There, it is held in place with special stitches through mull swabs or screws fixed in the skull.
The advantage of endoscopic procedures is small scars and gentler and kinder operation in general. This method is particularly suitable for forehead skin that is less sagging, with only beginning and not very deep mimic wrinkles. The effect of the surgery is then good and when the mimic muscles are interrupted, the formation of deeper wrinkles between the brows and at the nose root may be stopped in time.
As scarring is small, endoscopic forehead lift procedures are equally recommendable to men.
The precondition of the operation is a good general condition of health and a good condition of the skin without any centres of inflammation. The operation is performed either under a combination of local and general anaesthesia using so-called neuroleptanalgesia, which means that anaesthesia is controlled intravenously and the patient is kept sleepy or under general anaesthesia for the period of the operation.
The classic procedure is carried out by making an incision in the hairy part above the forehead, some 2-3 cm above the hairline. The course of the incision runs parallelly. The hair is parted at the place of the incision. The incision is terminated in the area of the temples at either side. The skin is elevated to the incision and the excessive part of the scalp is removed. The resulting scar will be hidden in the hair.
In the endoscopic procedure, two incisions about 1 cm long and running from front to back are made in the middle above the hairline as well as 2 slightly broken incisions above the hairline in the temple area.
The surgery is concluded by applying an elastic plaster and an elastic bandage around the head, which is to thoroughly press the skin to the forehead base so that it reattaches quickly and without any problems.
When the course of the post-operation period is uncomplicated, the patient stays in hospital overnight. On the following day, the first rebandage is made.
The bandage is replaced and the patient, having been instructed as what to do, is discharged home care.
Initially, facial swelling may appear, mostly in the area of eyelids. Bruising in this area is also inevitable in the course of post-operation period (with endoscopic procedures, the swelling and the bruising is usually smaller and fades more quickly). One’s temperature may rise as high as 38°C. Unless it is in excess of the limit and lasts for a long time, the condition is considered to be normal. Otherwise, a check-up at our clinic is inevitable.
Swellings may be soothed by applying cold compresses and the temperature may be lowered with appropriate medication (without content of acetyl salicylic acid, e.g. Paralen). The patient will be given pain-relieving drugs upon discharge. Feelings of discomfort and numbness in the affected areas are usual post-surgery side effects and will recede in several weeks.
Until the bandage is removed, typically on day 1-5 after surgery, a regimen of rest is required to reduce the risk of post-operative bleeding and facial swelling. After the bandage is removed, hair should be washed, and afterwards, the healing process continues without any bandages. The head should be washed on a regular basis once a day. Elastic fixation with a wrap or a headband is required for a minimum of 7 – 10 days. The same is required at night for 10 – 14 days. Following examinations and check-ups are carried out according to specific findings. The sutures will be removed on the 10th to 14th day after the surgery.
The data presented is based on a common post-operation course. However, a recovery is an individual process depending not only on healing abilities of any individual body, but also on every patient´s conscientiousness.
The patient is expected to set such conditions for a period of several days after his operation to be able, in case of any subjective problems or complication, to come as soon as possible for examination to our department.
A positive operation result and mutual satisfaction is in your interest as well as in ours. Mutual trust and co-operation of the patient with the surgeon is a vital precondition.