The main difference among the various options for forehead lifting consists of the placement of the incision. The original technique is the coronal incision, which is made slightly behind the natural hairline. An alternative is the pre-trichial incision. This is similar to the coronal incision except that the mid-portion of the incision is made directly at the hairline. This incision generally heals favorably and has the advantage of lowering the hairline. The disadvantage could be noticeable scarring. An option is to place the incision within the mid-forehead creases. This is primarily used in men with deep pre-existing forehead lines. A more recent approach is endoscopic forehead lift surgery. Several small one-half-inch to one-inch incisions are placed just behind the hairline. Although this technique may require more surgery time, it is less invasive and results in a smaller chance of temporary scalp numbness. A Mini Lateral Brow Lift, is a modification of a full brow lift. Very small incision are placed in the hairline in the temple region and the corners of the brow are pulled up. This give women the pleasant arched shape. Depending on the type of browlift procedure being performed, it takes between one to two hours to perform. It is most commonly performed under local anesthesia, IV sedation (twilight anesthesia). Not infrequently, a brow lift is combined with blepharoplasty (an eyelid tuck) or face lift to provide a harmonious rejuvenation. Micro Fat Transfer-The Problem : As we age, the layer of fat under our facial skin begins to thin. This causes the face to look deflated and drawn when compared to the full roundness of a younger face. Especially around the eyes, hollows and contour changes leave the face looking older and more tired. Volume loss is one of the earliest signs of aging. It starts to occur in the mid 30's and continues to progress. Until recently, this component of facial aging was overlooked. We are now realizing what a major contribution volume makes to looking younger, healthier and more energetic. The Treatment : One of the old dictums in plastic surgery is "replace like with like." When it comes to facial volume loss, micro fat transfer is the treatment of choice. A gentle liposuction technique is used to prepare the fat for transfer. Then the fat is then injected in the desired portion of the face, using a micro injection technique. This approach allows extremely small parcels of fat to be placed into multiple layers of the face. This maximizes potential survival and allows for optimal aesthetic outcome. In my practice this is done most commonly around the hollows and grooves of the lower eyelid region and cheeks. It is also placed on the upper eyelid region and just beneath the eyebrow. Anesthesia : The procedure is most commonly performed under local anesthesia with a light oral sedation. Patients go home the same day with little discomfort and essentially no downtime. Bruising is variable. Expected Outcomes: Generally, 40-60% of the transferred fat persists permanently. Although, the long-term efficacy of transferred fat has been documented in numerous studies results are extremely technique dependent. I encourage all my prospective patients to speak to past patients and ask them what their experience has been with the long-term results. Post Operative Course: Other than a very small incision at the fat harvesting site, no incisions are made in the face. The most common post procedure issues are swelling and bruising. This is often minimal and often resolves in a few days. Patients usually return to normal activity within a week. The more regions of the face that are treated, the more time it takes for the swelling to settle.
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