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A forehead lift is a common cosmetic surgery procedure performed to correct forehead wrinkles and sagging eyebrows, and to reduce the appearance of heaviness around the eyes.

 

This article focuses on the “incisional forehead lift” and provides a systematic explanation from a cosmetic surgery perspective, covering everything from the principles of incision line design, the indications for each surgical technique, scar management, downtime, and postoperative care to the risks of complications and strategies for preventing them.

 

[Doctor’s Point]

The main concern patients have about a forehead lift is whether the scars will be noticeable.

In reality, the final result is determined more by "where to make the incision" and "how to suture" than by the act of making the incision itself.

 

When designing the incision site, I take into account the shape of the hairline, the direction of hair growth, and even the patient’s future hairstyles. Because I prioritize maintaining a natural appearance after surgery—not just minimizing scarring—I avoid forced lifting or excessive skin removal, and instead develop a treatment plan while carefully considering the overall balance of the face.

 

Basics of Forehead Lifts (Incision Method) Performed in Cosmetic Surgery

A forehead lift is a procedure that lifts the entire area from the forehead to the eyebrows upward and outward, reducing wrinkles and sagging caused by excessive tension in the facial muscles and skin laxity.

 

The incision method is characterized by its ability to achieve a firm and long-lasting lifting effect through thorough dissection and fixation of the skin and soft tissues.

 

While endoscopic approaches are also widely known, this article focuses on the “forehead lift with incision,” highlighting the key points regarding the location of the incision line, the choice of tissue planes, fixation methods, and scar care.

 

In cosmetic surgery, we comprehensively evaluate each patient’s skeletal structure (the shape of the frontal bone and the degree of protrusion of the superior orbital rim), hairline position and density, skin thickness, wrinkle patterns, the difference in eyebrow height, and medical history (such as previous upper eyelid surgery, forehead fillers, or Botox) to determine the type of incision line.

 

The design expertise and sewing techniques used here determine whether the finished product looks natural and lasts a long time.

Anatomy and Design: How to Choose an Incision Line

Key Points on the Anatomy of the Forehead and Scalp

When planning an incision technique, one must first understand the layered structure—skin, subcutaneous tissue, galea aponeurotica, loose connective tissue, and periosteum—and then decide at which layer to perform dissection and fixation.

 

In the forehead region, by properly addressing the course of the frontalis muscle and the release points above and below the periosteum (particularly the fixed ligaments near the superior orbital rim), it is possible to adjust the tension and direction of traction that cause wrinkles.

 

In the temporal region, it is important to consider the two-layered structure of the temporal fascia and the superficial temporal fascia, and it is essential to take the frontal branch (facial nerve) into account.

Types of Incision Techniques and Their Indications

The typical incision sites and their indications are as follows. Since the degree of postoperative scar visibility, the impact on the hairline, and the flexibility in the direction of the lift vary, a customized approach is standard practice in cosmetic surgery.

 

• Coronal Incision (coronal incision at the crown): This technique allows for extensive dissection and is effective for lifting the entire forehead and the lateral areas. Because the incision is made behind the hairline, the scar is easily concealed; however, it tends to make the forehead appear wider in cases of a receding hairline.
• Hairline Incision (Pre-trichial/Trichophytic): This technique involves making fine, zigzag incisions along the hairline and using trichophytic sutures to preserve hair follicles, allowing hair to grow across the scar. It is suitable for patients who wish to lift their hairline while maintaining its height or who wish to make their forehead appear relatively shorter.
• Mid-scalp incision: An incision is made midway between the hairline and the crown to minimize visible scarring. The degree of freedom regarding the extent of dissection and the direction of fixation is moderate.
• Temporal incision: Highly effective for lifting the outer eyebrows and treating crow’s feet (wrinkles at the outer corners of the eyes), with relatively short downtime. However, when used alone, it has limited effectiveness for deep wrinkles in the central forehead.

 

For any type of incision, the key to improving scar quality lies in performing multilayer suturing designed to distribute tension, protecting hair follicles in the hair-bearing area, preserving blood supply, and avoiding excessive skin excision.

Cosmetic Surgery Consultations and Determination of Suitability

During your initial consultation at a cosmetic surgery clinic, discuss the extent of changes you’d like to achieve (the degree of elevation at the inner, middle, and the degree of elevation at the outer end of the eyebrow), the degree of receding hairline, the vertical width of the forehead, the thickness of the fat and skin above the eyebrows, facial expression habits (such as the habit of making a surprised expression), tendency to scar, medical history, and your tolerance for social downtime.

 

Depending on the desired natural look—whether you want to eliminate a tired appearance or achieve a more lifted, radiant look—we will recommend the incision site, the direction of the lift, the fixation method (periosteal fixation or soft tissue suspension), and any additional procedures (such as upper eyelid skin excision, lateral canthoplasty, or forehead Botox re-design).

 

Referencing "Before" and "After" photos is helpful in reaching a consensus on the results. It is recommended to provide guide lines indicating the amount of lift on both sides and to verify the relationship between the eyebrows and the upper eyelids, the depth of forehead wrinkles, and the appearance of the hairline using photos taken with consistent lighting and angles.

Surgical Procedure (Open Surgery)

At many cosmetic surgery clinics, the procedure proceeds in the following order: marking → anesthesia → incision and dissection → release → fixation → hemostasis → suturing.

• Marking: While seated, check the balance between the ideal eyebrow position and the hairline. Determine the incision line by overlaying the excess skin and wrinkle patterns on the face when smiling, raising the eyebrows, and furrowing the brows.
• Anesthesia: Intravenous anesthesia combined with local infiltration is standard. General anesthesia may be chosen for procedures involving prolonged duration or extensive dissection.
• Dissection and Release: Carefully release adhesions in the superior orbital rim’s suspensory ligaments and the lateral orbit at appropriate levels, such as the Galea and subperiosteal spaces. Adjust the tension of the frontalis muscle, taking care to avoid lateral crow’s feet.
• Fixation: Retention is ensured through periosteal anchor sutures and deep tissue suspension. Real-time fine-tuning is performed to correct any asymmetry between the left and right sides.
• Suturing and Dressing: Perform multilayer suturing to distribute tension, paying particular attention to trichophytic suturing along the hairline. Manage drains as needed.

Safety Measures and Risk Management in Cosmetic Surgery

Major risks include bleeding and hematomas, infection, uneven or enlarged scars, irregular hair growth (localized hair loss), decreased sensation (numbness in the forehead), asymmetry, overcorrection or undercorrection, unnatural facial expressions, and the risk of damage to the frontal branch of the facial nerve.

 

In cosmetic surgery, prevention is achieved through strict adherence to anatomical planes, minimizing thermal injury, ensuring thorough hemostasis, optimizing dressing pressure, providing smoking cessation counseling, and managing anticoagulant medications.

 

Practical measures for reducing risk include preoperative assessment of blood pressure and bleeding tendency, careful control of venous bleeding during surgery, appropriate compression for 48 hours postoperatively, and educating patients about early signs of hematoma (sudden unilateral swelling, pain, and tenderness).

 

Early intervention is key in managing complications, and effective communication between the surgeon and the patient is essential.

Downtime and Aftercare

Swelling and bruising typically peak 3 to 5 days after surgery and become less noticeable within 7 to 14 days. Stitches are generally removed 7 to 14 days after surgery. Sensory abnormalities usually improve within a few weeks to a few months.

 

The return-to-work schedule is typically set at 1 to 2 weeks for desk work, and 2 to 3 weeks for jobs involving customer interaction or filming.

• Cooling and Elevation: Control swelling by applying cold compresses and elevating the head for 48 hours after surgery.
• Shampooing: Follow your doctor’s instructions and gently wash your hair with lukewarm water 24 to 72 hours after the procedure. Do not rub your scalp, and use a hair dryer on a low setting with cool air.
• Sō Care: It is generally recommended to start using silicone gel or tape after the sutures are removed. Use UV protection (SPF and a hat) to prevent hyperpigmentation.
• Exercise: For the first 1–2 weeks, limit yourself to light walking. Gradually resume strength training and high-intensity aerobic exercise starting in the 3rd or 4th week.
• Facial Muscle Care: The habit of raising the eyebrows excessively is a factor in recurrence. Provide guidance on facial rehabilitation as needed.

To evaluate the results, we use standardized "before and after" photographs, taken from the front, at an angle, and from the side, all at the same distance and under the same lighting conditions.

 

Let’s conduct regular observations of the relationship between the inner and outer corners of the eyebrows and the pupils and the amount of visible sclera, as well as the hairline and changes in the depth of the midline forehead wrinkles.

 

Please note that, as mentioned at the beginning, this article is a general overview based on general principles rather than data from a specific clinic. Be sure to check with the cosmetic surgery clinic where you plan to receive treatment regarding specific aftercare procedures and the frequency of follow-up visits.

Finish and Longevity

A forehead lift using an open technique can be expected to provide medium- to long-term results, provided that proper tissue release and fixation are performed.

 

Although individual results may vary due to differences in skin and soft tissue, daily facial expressions, and environmental factors such as UV exposure and smoking, external lifts tend to last relatively longer.

 

The key to a natural-looking result lies in a design that avoids overcorrection and respects the balance between the curve of the brow bone and the volume of the eyelid.

Estimated Costs and How to Approach Quotes (From a Cosmetic Surgery Perspective)

Costs vary depending on the incision site (coronal, hairline, or temporal), the extent of tissue dissection, the fixation method, the type of anesthesia, the facility’s resources, whether additional procedures (such as upper eyelid surgery or a facelift) are performed, and the difficulty of the procedure (whether it is a revision or a first-time surgery).

 

In cosmetic surgery, it is generally considered best practice to clearly outline the breakdown of total costs—including consultation fees, surgical procedure fees, anesthesia, medications, follow-up visits, and the policy for managing complications should they occur—along with the results of the consultation evaluation, photo analysis, and risk disclosure.

Frequently Asked Questions (Cosmetic Surgery)

Q1. Are the scars noticeable?
The design, which keeps the incision within the hairline and scalp, along with trichophytic suturing and tension-relieving techniques, helps minimize the visibility of the scar. Since results may vary depending on your body type and post-operative care, be sure to discuss a personalized scar management plan with your plastic surgeon.

 

Q2. Will hair loss or irregular hair growth occur?
Temporary hair loss may occur due to damage to hair follicles along the incision line. This can be minimized by using incision and suturing techniques that preserve the hair follicles, as well as by avoiding friction and ensuring adequate blood flow after surgery.

 

Q3. Won't my eyebrows look unnatural if they're raised too high?
This is prevented by marking the teeth while the patient is seated, confirming bilateral balance during surgery, and designing the vector with a lateral bias. Since overcorrection is easily visible even during the initial swelling phase, the treatment plan is adjusted to account for the swelling subsiding over time.

 

Q4. How much time off do you need?
Although results vary from person to person, a general guideline is 1 to 2 weeks for desk work and 2 to 3 weeks for in-person work. Please follow the post-operative instructions provided by the cosmetic surgery clinic where you had your procedure.

 

Q5. Can this be used in combination with eyelid surgery or Botox?
It is common to combine procedures. Since the results can vary depending on the order and timing, a cosmetic surgery clinic will determine the optimal schedule based on an overall design plan.

 

Q6. What is the difference between the open surgical method and the endoscopic method?
The surgical method offers greater flexibility in dissection and fixation, as well as long-lasting results, while the endoscopic method has the advantages of minimal scarring and a quick recovery. The choice depends on the hairline, the desired extent of change, and the patient’s tolerance for downtime.

 

A forehead lift with an incision is an effective option for restoring balance to the forehead and eyebrows over the medium to long term.

The key lies in designing an incision line tailored to each patient’s individual bone structure, hairline, and facial expressions, as well as careful layer selection, precise tissue release, secure fixation, meticulous suturing, and consistent postoperative care.

 

This article is not a specific introduction to a particular clinic based on publicly available information, but rather a general explanation. Your final decision should be based on a thorough consultation at a reputable cosmetic surgery clinic and a review of standardized “Before & After” photos.

 

To ensure your safety and satisfaction, we strongly recommend that you receive a thorough explanation—including a breakdown of costs, downtime, and the policy for handling complications—until you are fully satisfied.

 

Summary

A forehead lift using an incision is a treatment that can fundamentally correct sagging of the eyebrows and forehead; however, the suitability of the procedure, downtime, and the appearance of the scar vary depending on the surgical technique and incision location.

 

To achieve a natural-looking result, it’s important to create a design that takes into account not only lifting the eyebrows but also the hairline, facial structure, eyebrow placement, and facial expressions.

 

In addition, since postoperative wound care and lifestyle habits can affect how the scar heals, it’s a good idea to confirm that the clinic offers a support system that includes aftercare. When considering the procedure, be sure to undergo a thorough consultation and choose a treatment only after you are fully satisfied with the surgical technique and incision design that best suit your needs.

 

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