Forehead surgery is a recognized field of cosmetic and reconstructive procedures focusing on the upper third of the face. This area significantly influences overall facial aesthetics, and surgical interventions address various concerns. Procedures range from modifying soft tissues to counteract aging effects to altering the underlying skeletal structure for contouring or proportional changes. The goal is to create a more harmonious, balanced, or rejuvenated appearance.
Procedures Addressing Skin Laxity and Wrinkles
Aging often leads to a descent of the brow line, creating an aged appearance and deepening horizontal forehead creases. The surgical correction is commonly known as a brow lift or forehead lift. This procedure elevates the soft tissues of the upper face and repositions the muscles that cause frown lines, resulting in a smoother forehead, a more open look around the eyes, and a refreshed brow position.
Two primary techniques are used for a brow lift: the endoscopic lift and the coronal lift. The endoscopic approach is less invasive, utilizing small incisions hidden within the hairline for instrument insertion. This method is preferred for patients with mild to moderate signs of aging, resulting in less tissue trauma and quicker initial recovery.
In contrast, the coronal lift is a traditional technique involving a longer, ear-to-ear incision made behind the hairline. This approach allows for the removal of excess skin and provides greater access to underlying muscles, making it suitable for more advanced signs of aging. A variation, the hairline or pretrichial lift, places the incision directly at the hairline, allowing for brow elevation while also lowering a high hairline.
Procedures Addressing Bone Structure and Hairline Position
This category includes complex procedures designed to alter the underlying bony shape or dimensions of the forehead.
Forehead Reduction
Forehead reduction, also called hairline lowering or scalp advancement, is a soft tissue surgery that reduces the vertical height of a high forehead. The surgeon makes an incision along the hairline, removes a strip of non-hair-bearing skin, and advances the hair-bearing scalp forward. This effectively lowers the hairline, often achieving a reduction of about 2 centimeters in a single stage, creating a more proportionate facial third.
Forehead Contouring
Forehead contouring or reshaping modifies the frontal bone, often to reduce a prominent brow ridge, known as brow bossing. This surgery is frequently performed as part of facial feminization but is also sought by others dissatisfied with their forehead shape. The procedure’s complexity is classified into types based on the thickness of the frontal bone and the presence of the frontal sinus.
The most comprehensive technique is Type 3 forehead setback, required when shaving the bone down (Type 1) would expose the frontal sinus cavity. This procedure involves surgically removing the outer plate of the frontal sinus bone, reshaping it to a flatter contour, and setting it back into a recessed position. It is then secured with small plates and screws to achieve a significant reduction of the brow ridge and a smoother, more rounded profile.
What to Expect During Recovery
Following most forehead procedures, patients should expect swelling, bruising, and tightness around the forehead and eyes. The initial 48 to 72 hours are the most intense recovery phase, with swelling typically peaking around the third day. To manage swelling, patients are advised to keep their head elevated at a 30 to 45-degree angle, even while sleeping, and to use cold compresses.
Temporary changes in sensation are common, including numbness, tingling, or itching along the incision lines due to nerve manipulation. While discomfort is managed with prescribed pain medication, strenuous activities and heavy lifting must be avoided for four to six weeks. Most individuals return to desk-based jobs or light activities within seven to fourteen days, once the majority of swelling and bruising has subsided.
Incisions are often hidden within the hair or placed along the natural hairline. Temporary hair loss, sometimes called “shock loss,” can occur near the surgical site, but hair growth typically returns over the following months. Although initial results are visible within a few weeks, the final contours and resolution of residual swelling can take three to six months to fully emerge.