Forehead

“I Look Tired and Droopy”
It is all too often that family and friends come up to us and say “you look tired, did you get enough rest last night?”  Too many times we feel rested and feel fine, but our face tells a different story.

Aging of the Upper Eyes and Upper Forehead
The first areas to show signs of aging are the regions around the eyes and forehead.  This becomes particularly noticeable in one’s mid to late 30s and particularly in the 40s.  Heredity, stress, poor diet, poor health, sun exposure, and time all contribute to the severity of this aging process.  These time-related physiologic changes are dependent upon each particular individual’s response.

In one’s 20s, overlapping folds of skin of the upper eyelids slowly develop. This laxity and droopiness becomes more noticeable in one’s 30s and worsens in one’s 40s.  The resultant appearance is fatigue and one appears depressed and tired. Horizontal forehead lines develop due to consistent and persistent attempts to elevate the eyebrows and open the eyes.

The typical signs of aging of the upper forehead that render the fatigued look are development of prominent horizontal forehead creases, prominent glabellar furrow, droopy eyebrows, and droopy upper eyelids.  Many times, all four of these characteristics will develop over time.  The endoscopic brow lift elevates the descended eyebrow, reduces the fullness of the upper eyelid, reduces the horizontal lines of the forehead, and diminishes the worry lines between the eyes.  The ultimate result is youthfulness and significant elimination of the “fatigued” and “worried” appearance.

The Procedure
The endoscopic brow lift is performed under IV sedation with local anesthesia or can be performed under general anesthesia with tumescent technique. The procedure takes approximately 30 to 45 minutes.  Small incisions are created behind the hairline, measuring less than 2-cm in length. These incisions hide quite nicely in the hairline. This minimally invasive technique of endoscopic visualization is performed using a fiber optic endoscope. Visualization is in an exact plane beneath the scalp and subcutaneous tissue. Tissue is released and repositioned to appear more youthful. The hairline is slightly raised. The eyebrows and redundant eyelid skin are also repositioned upward. The forehead glabellar muscles, which cause the facial expressions of worry, concern, and fatigue are trimmed. A muscle sectioning procedure is performed in the central portion of the forehead to these muscles. Following the healing process, the muscles will not contract as much and the sense of worry and fatigue will be resolved.

The endoscopic forehead lift is minimally invasive and is a significant advancement to the realm of facial plastic surgery.  Small incisions hide quite nicely and there is no need for the “coronal lift approach”, which is considered an outdated procedure and is only performed on rare occasion.