A forehead lift or "browlift" is a procedure that restores a more youthful, rested look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired. In a forehead lift, the muscles and tissues that cause the furrowing or drooping are altered to smooth the forehead, raise the eyebrows and minimize frown lines. This is performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed without visible incisions. The best candidates for a forehead lift A forehead lift is most commonly performed in the 40-60 age range to minimize the visible effects of aging. However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this procedure. Sometimes, patients who believe they need upper eyelid surgery find that a forehead lift better meets their surgical goals. Patients who are bald, who have a receding hairline, or who have had previous upper eyelid surgery may still be good candidates for a forehead lift. Planning your surgery For a better understanding of how a forehead lift might change your appearance, look into a mirror and place the palms of your hands at the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. That is approximately what a forehead lift would do for you. During your consultation, the surgeon will discuss your goals for the surgery and ask you about certain medical conditions that could cause problems during or after the procedure, such as uncontrolled high blood pressure, or blood clotting problems. Be sure to tell the surgeon if you had previous facial surgery, if you smoke, or if you take any drugs or medications-including aspirin or other drugs that affect clotting. If you decide to proceed with an endoscopic forehead lift, your surgeon will explain the surgical technique, the recommend type of anesthesia, the risks and the costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results of surgery. Preparing for your surgery Your surgeon will give you specific instructions to prepare for the procedure, including guidelines on eating, drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help your surgery and your recovery proceed more smoothly. You should arrange for someone to drive you home after your surgery, and to help you out the first day. Where your surgery will be performed An endoscopic forehead lift is done in a surgeon's office-based facility. Types of anesthesia Endoscopic brow lift is performed under general anesthesia or conscious sedation. The surgery Your surgeon will explain the surgical technique to you during your consultation. Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be moved and the muscles of the forehead can be altered or released. The eyebrows may also be elevated Your surgeon will make three or five short scalp incisions, each less than an inch in length. An endoscope, which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing the surgeon to have a clear view of the muscles and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are moved or altered to produce a smoother appearance. The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin's surface. When the lift is complete, the scalp incisions will be closed with stitches or clips and the area will be washed. Gauze and an elastic bandage may also be used depending on your surgeon's preference. After your surgery You may be told to keep your head elevated for two to three days following surgery to keep the swelling down. Swelling may also affect the cheeks and eyes however, this should begin to disappear in a week or so. If bandages were used, they will be removed a day or two after surgery. Most stitches or clips will be removed within one week, sometimes in two stages. Endoscopic Forehead Lift patients experience some numbness, incision discomfort and mild swelling. Incision site pain is usually minimal, but can be controlled with medication, if necessary. The stitches or staples used to close the incisions are usually removed within a week. A small suction drain is left under the skin for the first 1-2 days following surgery. Getting back to normal Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery. You should be able to shower and shampoo your hair within two days, or as soon as the bandage is removed. Most patients are back to work or school in a week to ten days. Vigorous physical activity should be limited for several weeks, including jogging, bending, heavy housework, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for the first week. Most of the visible signs of surgery should fade completely within about three weeks. Minor swelling and bruising can be concealed with makeup. Your new look Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often, patients don't realize how much their sagging forehead contributed to the signs of aging until they see how much younger and more rested they appear after the lift. Although a forehead lift does not stop the clock, it can minimize the appearance of aging for years. All surgery carries some uncertainty and risk Complications are rare and usually minor when a forehead lift is performed by a qualified plastic surgeon. In rare cases, the nerves that control the eyebrow movement may be injured on one or both sides, resulting in the loss of ability to raise the eyebrows or wrinkle the forehead. Loss of sensation is usually temporary, but may be permanent in some patients. Infection and bleeding are very rare, but are possibilities. If a complication should occur during an endoscopic forehead lift, your surgeon may have to abandon the endoscopic approach and switch to the conventional, open procedure, which will result in a more extensive scar and a longer recovery period. To date, such complications are rare, estimated at less than 1 percent of all endoscopy procedures. You can reduce your risk of complications by closely following your surgeon's instructions both before and after your surgery.