American Medical Association Family Medical Guide - American Medical Association [774]
In open surgery, a surgeon makes an incision either behind or directly at the person’s hairline and removes excess tissue from the forehead. The incision can also be made inside one of the natural creases in the forehead; this option is usually used in men who already have deep lines in their forehead. After removing the excess tissue, the surgeon replaces the forehead skin over the brow and stitches it in place.
Open forehead lift surgery takes 1 or 2 hours; endoscopic forehead lift surgery may take a bit longer. Done on an outpatient basis, either procedure may be performed using a local anesthetic (with sedation) or general anesthesia.
After Surgery
You will probably experience headaches, swelling, and bruising during the first 3 weeks after surgery. You may also feel numbness and itching in your forehead and scalp for a few months. Some people lose some hair near the incision site, but the hair loss is usually temporary. Rare complications include infection, bleeding, and noticeable scarring.
The doctor will remove any stitches that are not dissolvable about 7 to 10 days after your surgery, at which time you will also be able to return to work and other routine activities. You can resume more vigorous activities after a few more weeks. You will need to limit sun exposure on your forehead for several months, even if you wear sunscreen. Prolonged bruising can be masked with makeup.
Reducing Frown Lines With Botulinum Toxin
Many people avoid surgery altogether by reducing their frown lines with injections of botulinum toxin type A, a protein made by the bacterium Clostridium botulinum. When a doctor injects the toxin into a facial muscle, it causes temporary paralysis of the muscle that lasts for several months. The paralyzed muscle is no longer able to pull the skin of the face into furrows, which relaxes wrinkling and smoothes out the skin. The procedure works best on forehead lines, crow’s feet around the eyes, and lines between the eyebrows. The procedure takes about 10 minutes, and the wrinkle-relaxing results take effect in about 1 to 5 days.
Botulinum toxin should be injected using the lowest effective dose. Common side effects include mild swelling and numbness at the injection site, headache, bruising, a rash, nausea, and drooping eyelids, but these effects are temporary. Some people who have had botulinum toxin injections report temporary relief from migraine headaches.
Facelift
Plastic surgeons perform facelifts to restore a more youthful appearance to the face and neck by elevating the facial skin and removing excess tissue. A facelift can eliminate deep lines that run from the corner of the nose to the corner of the mouth, get rid of jowls at the jawline, and remove loose skin and fat from the neck. Features such as sagging eyebrows and eyelids or wrinkles around the mouth cannot be corrected by a facelift, but additional surgery to resolve these problems can be performed at the same time as or after a facelift. Most people who have a facelift are between ages 40 and 70, but older people can also be good candidates.
The Procedure
A facelift is usually an outpatient procedure that takes several hours. During the surgery, the surgeon makes incisions above the hairline (where they can be concealed) starting at the temples and extending down in front of and behind the ear to the lower scalp. The surgeon may also make a tiny incision under the chin to access the tissue in the neck. The surgeon first separates the skin from the underlying fat and muscle. If necessary, he or she may trim or suction fat from the neck and chin. Then the surgeon tightens the muscles and deeper connective tissues, draws the skin back tight, and trims off the excess skin. The incisions are closed with stitches. Tubes may be placed under the skin behind the ears to drain collected blood and fluid. The surgeon may also cover the person’s head in loose bandages to minimize swelling; the bandages