There are two main types of forehead lifts. The classic, or open, forehead lift involves a long incision along the top of the forehead and lifting of the skin of the forehead. The second type of forehead lift, known as an endoscopic lift, is performed with special instruments inserted through four or five small incisions behind the hairline.

In some cases, a forehead lift is combined with plastic surgery on the eyelids ( blepharoplasty ) or with a face lift .

Classic forehead lift: The classic forehead lift takes about one to two hours and may be performed with either general or local anesthesia. After the patient has been anesthetized, the surgeon makes a long incision across the top of the scalp from ear to ear. The exact location of the incision depends on the condition of the facial muscles to be removed or modified and the position of the patient’s hair-line. The most common type of incision in an open forehead lift is a coronal incision, which is made slightly behind the hairline. A second type of incision is called a pretrichial incision. It is similar to the coronal incision except that the central part of the incision lies directly on the hairline. A third type of incision, which is used mostly on male patients with very deep forehead creases, is placed directly inside the creases in the midforehead.

After the incision has been made, the surgeon lifts the skin of the forehead very carefully and cuts away excess underlying tissue. Some of the muscles that cause frowning may be loosened (released) or altered. If necessary, the brows will be lifted and excess skin along the line of the incision will be trimmed away. The incision is usually closed with stitches or staples, although some surgeons are now using tissue glues to hold the skin in place. The patient’s face is then carefully washed to prevent infection and irritation. Some surgeons prefer to cover the incision with a gauze dressing held in place by an elastic bandage, but others do not apply any dressing.

One disadvantage of the classic forehead lift from the standpoint of male patients is that men’s hairstyles will not usually cover the incision scar. It is easier for women, even those who prefer to wear their hair very short, to let the hair grow for several weeks before the procedure so that it will be long enough to cover the scar.

Endoscopic forehead lift:An endoscopic forehead lift is performed with the help of an endoscope, which is an instrument designed to allow the surgeon to see the tissues and other structures underneath the skin of the forehead. Instead of making one long incision, the surgeon makes four or five shorter incisions, each less than an inch (2.5 cm) long. The endoscope is inserted through one of these incisions; the others are used for the insertion of instruments for removing excess tissue and reshaping the facial muscles. If the eyebrows are being lifted, they may be kept in place in their new position by tiny stitches under the skin or fixation tacks placed behind the hairline. The incisions are closed and the patient’s face washed and dressed in the same way as in the classic forehead lift.