How is this procedure done?

Forehead lifts are done using one of two surgical approaches. One is called the classic lift and the other is called the endoscopic lift. Make sure your surgeon explains to you which approach he or she is taking and why they feel it is best for you.

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The classic lift

Prior to your procedure your surgeon will tie your hair back with rubber bands. Your head will not be shaved, but some hair along your incision line may need to be slightly trimmed. Your surgeon will use an incision that follows the shape of a headset. It will start about ear level and run across the tip of your forehead and down the other side of your head to your ear. In general, the incision will be made along or slightly above your hairline so its scar will not be visible. If your hair line is very low, your surgeon can raise it by placing your incision near the top of your head. Conversely, if your hair line is quite high, your surgeon can lower it an inch or so by making the incision in your hairline.

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The classic lift (cont.)

To work through the incision, your surgeon will carefully lift your forehead skin so that your underlying forehead tissue can be adjusted and/or removed to help create your new appearance. Your surgeon also may elevate your eyebrows and the skin near your incision may be trimmed to help create a more naturally upbeat expression. Your incision will be closed with stitches or clips and your hair and face will be washed to minimize any irritation. Your closed incision will then be covered with gauze padding and your head will be wrapped with an elastic bandage.

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The endoscopic lift

Surgical preparation with the endoscopic approach is similar to that of the classic lift. However, as opposed to making one long incision, your surgeon will make four or five short incisions in your scalp, each less than an inch in length. Your surgeon will then insert an endoscope (a small, pencil-like camera device) through one of the incisions. The endoscope is connected to a television monitor that enables your surgeon to clearly see the muscle and tissue under your skin. Using another small instrument that is simultaneously inserted through one of the other incisions, your surgeon will adjust, alter or remove underlying tissues to give your forehead a more smooth, youthful appearance. Your eyebrows also may be lifted into a slightly higher position in this manner. Your incisions will then be closed with stitches or clips and your face and forehead will be washed to reduce any skin irritation. Gauze and an elastic bandage will normally be wrapped around your head as well.

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How do I prepare for this procedure?

During your consultation with a surgeon, he or she will evaluate your face's skin and underlying bones. It is very important that you speak honestly to your surgeon about your goals and expectations. Your surgeon will want to know if you've had any previous facial surgeries. Your surgeon also will want to speak to you about your medical history. In particular he or she will ask you about any problems you've had with high blood pressure, blood clotting or a tendency to develop large scars. It will be important to tell your surgeon if you smoke or if you take any medications, because certain drugs can effect blood clotting. Depending on your individual medical history, your physician will provide you with specific instructions to follow prior to your procedure. These instructions will include guidelines about your diet, drinking, smoking and what vitamins and medications to either take or avoid. Following your surgeon's instructions will make your procedure and recovery a much smoother process.

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How do I prepare for this procedure? (cont.)

If your bangs are short, you may choose to let them grow out before your surgery so they may cover your incision scars while they heal. You also should make arrangements ahead of time for someone to drive you to and from your procedure and to help you out around your home for a couple of days.

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How long does the procedure take?

Forehead lifts normally take one to two hours, depending on the complexity of your individual procedure.

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What form of anesthesia is used?

In most cases, forehead lifts are performed using local anesthesia along with a sedative to make you feel drowsy and relaxed. You'll be awake and you may feel slight tugging sensations and some mild discomfort, but your forehead will be insensitive to pain. There are some surgeons who prefer to use general anesthesia, which means you'll be asleep during the entire procedure.

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Can I return home the same day?

Forehead lifts are performed on an outpatient basis so you can return home the same day. Since a local anesthetic and sedative are typically used, you should arrange for someone to drive you home from the procedure. If you are combining your surgery with other cosmetic procedures, your surgeon may recommend an overnight hospital stay.

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What precautions should I take during my recovery?

You should rest and be relatively inactive for the first two days after your procedure. After you begin to get up and about you should still plan on relaxing for about a week. Your bandages will be removed after about two days and you will be able to wash and shampoo your hair. Other precautions your surgeon will ask you to take will be based on the surgical approach he or she used.

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Classic lift

Your surgeon may advise you to keep your head elevated for two or three days following your surgery to help keep swelling down. You also may experience some swelling around your eyes and cheeks; however, this should subside over a week or so. As your nerves begin to heal, you may begin to feel some itching on the top of your scalp. These sensations could take as long as six months to heal. Your doctor will remove your incision stitches or clips over the course of two weeks. They may all be removed at once or in stages. Your surgeon will make this determination based on your individual case.

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Endoscopic lift

The need to elevate your head for two days is usually not as necessary with the endoscopic approach because there is not as much swelling. You will still, however, experience mild swelling along with some incision discomfort and minor itching. All these symptoms should not be as pronounced as they are with the classic approach. Stitches or staples used to close the incisions are normally removed within a week.

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How long before I can return to normal activity?

Most women are ready to return to work after about 10 days. Patients whose procedure was performed using the endoscopic approach may feel ready to return even sooner. Slight residual bruising or swelling may last for up to two weeks, but it most cases you'll be able to cover it with makeup. You should avoid strenuous activities for several weeks. This would include jogging, heavy housework, sex and any other activity that increases your blood pressure. Extended exposure to the sun should be avoided for several months.

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What are some of the complications that can occur with my procedure?

Like any surgical procedure, a forehead lift poses the potential for certain complications. Potential risks are minimized when this procedure is performed by an experienced board-certified plastic surgeon. However, there still are certain potential risks that you should be aware of. In rare instances, the nerves that control eyebrow movement can be injured during a forehead lift. This can result in a loss of the ability to raise your eyebrows and wrinkle your forehead. Should this occur, additional surgery may be needed to correct this condition. Another rare complication is the formation of a large scar at the incisions site, which may require additional surgery to correct. There also is the potential for some patients to lose hair along the edges of their scar.

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What are some of the complications that can occur with my procedure? (cont.)

Temporary loss of sensation along your incision line is common in patients who receive a classic forehead lift. However, for most patients this loss of sensation is only temporary, although it can be permanent. The potential for infection and bleeding is very rare, but the possibility does exist. If a complication should occur while your surgeon is performing an endoscopic procedure, he or she may have to abandon this approach and switch to the classic technique. Such an occurrence has proven to be rare, occurring in less than 1% of all endoscopic procedures. Following all of your surgeon's preoperative and postoperative instructions will help reduce the possibility of these complications occurring.

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What can I expect immediately after my procedure as well as later on?

Immediately after your procedure you may experience some numbness and discomfort around your incision area. This should be temporary and can minimized with prescription medication. These symptoms tend to be more pronounced if you have a classic forehead lift. If you are prone to headaches, you surgeon may elect to use a more longer-acting local anesthetic for your procedure. If you undergo a classic forehead lift, you may experience some hair loss or hair thinning around your incision. This condition should be temporary. Normal full hair growth should resume within a few weeks of your procedure. Permanent hair loss from a classic forehead lift is rare.

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What can I expect immediately after my procedure as well as later on? (cont.)

For both classic and endoscopic procedures, visible signs of your surgery should fade completely within a few weeks. Any minor swelling and bruising can be concealed with makeup or hair. As with any surgery, you may feel fatigued for some time after your procedure. However, your energy level should slowly pick up as you begin to feel and look better. Regardless of the surgical approach used, most women tend to be pleased with their long-term results. Many report they had no idea how much forehead lines and wrinkles made them look aged and tired, until a forehead lift helped restore a more youthful and vibrant look to their appearance. Results from forehead lifts normally last from 510 years and many women choose to repeat the procedure later in their lives.

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