WHAT IS NORMAL?
Four finger breadths of forehead before the hairline.
Smooth at rest, without horizontal wrinkles. Wrinkles during contraction of the forehead are normal.
No "frown lines" or creases between the eyes at rest.
COMMENT: A high forehead may be considered attractive in females, adding an open, exposed look to the face.
- 1. Measure the width of your forehead by four finger breadths.
- Completely relax your face for thirty seconds. No motion at all. Are there lines left?
HOW MUCH CAN BE IMPROVED?
- The forehead can be restored to laying flat, without wrinkles at rest.
- The hair line can be altered. It may be raised easily or lowered (less easily) with surgery.
- The contraction of muscles around the wrinkles can be eliminated.
THE OPTIONS: FOREHEAD
The forehead usually develops long wrinkle lines with age that can be very thick and disturbing. The horizontal lines are created by the frontalis muscle that forms a large sheet across the forehead and lifts up the brows.
Also, the vertical lines between the eyebrows known as "frown lines" may become more noticeable and persist at rest as people age. The frown lines are created by the corrugator muscles that attach skin to the nose.
THE STANDARD FOREHEAD LIFT
The forehead lift is the most common technique performed to improve the forehead and the eyebrows. In this procedure, the skin of the forehead is lifted up. After the entire forehead skin is elevated, the muscles between the eyebrows that make the frown lines are usually cut so that this area of the forehead no longer creases. This alone will greatly reduce the depth of the lines.
Secondly, there are several procedures that can be performed to weaken the forehead muscle and keep the forehead from contracting. Usually, the muscle is cut into a checkerboard pattern which greatly reduces its strength, or strips of the muscle may even be removed.
Finally, the surgeon may remove a strip of excess skin near the incision and sew the skin closed.
HAIRLINE VERSUS IN-THE-HAIR INCISION
The standard forehead lift may be done with the incision right at the hairline or about an inch behind the hairline (known as the coronal incision). If the incision is behind the hairline, it is hidden, but some hair may be lost if the surgeon removes excess skin at the edge. Also, the hairline will be moved higher depending on how much skin is removed, usually less than an inch. In some patients this is desirable, in others it may not be.
If the incision is at the hairline, the hairline will stay the same. However, the scar may show, particularly if excess skin is removed and there is tension on the hairline.
Recently, surgeons have focused more on reducing muscle function and less on skin removal, since the muscles are the cause of the problem.
FOREHEAD LIFT COMPLICATIONS
- ELEVATION OF HAIRLINE
If the incision is made in the hair, the hairline may be elevated.
May be noticeable if the incision is at the hairline and the hair is worn up. Usually improves a lot with time. Also, may be designed so that hair grows through the scar.
NUMBNESS/LOSS OF SENSATION
The nerves that give sensation to the forehead run vertically from the middle of the eyebrows. Surgeons are careful to avoid them.
PARALYSIS OF FOREHEAD MUSCLE
If this happens, the forehead lays flat. Usually, the other side is then cut so that the two sides match. Reduced muscle function of the forehead is the goal anyway.
If the muscle function is reduced enough, the improvement is usually excellent. The muscles tend to heal back together and create more wrinkles.