Because every person has a varying degree of sagging skin in the forehead, plastic surgeons today are using different types of brow lift surgery which are usually based on the length of the incision used.  But in general, the excision is placed behind or along the hairline in order to hide the scars.

For older patients, perhaps the most popular technique is the temporal brow lift which uses incisions made at the temples behind the hairline that will allow doctors to correct the wrinkles in the forehead, creases in the corners of the eyes or “crow’s feet,” and sagging cheeks.

If needed, this technique is performed with suture suspension in which plastic surgeons uses internal, permanent sutures to support the new, higher position of the muscles and tissues.

Another common technique for patients who need the most correction is the full coronal brow lift which involves making an extensive, temple-to-temple incision that runs across the crown of the head.  With this plastic surgery procedure, doctors can pull the muscle and skin upward and then tighten the forehead area.  If needed, they will also remove the excess skin that is causing the sagging appearance.

While this technique provides a dramatic result, there is a major downside which must be considered: the long incision may become visible for people who have thinning hair or receding hairline.

Because younger patients or those between the age of 35 and 50 usually need a minimal to moderate lift, plastic surgeons have developed a less invasive technique called endoscopic brow lift which uses a slender probe with a tiny camera attached to a screen.  Meanwhile, this instrument is inserted into three to six small incisions that are placed behind the hairline.

With this plastic surgery approach, patients can expect faster recovery, less post-operative pain and discomfort, minimal bleeding, and lower risk of scarring and other complications.

In some cases, the endoscopic brow lift is complemented with permanent sutures to support the muscles and tissues in the forehead in their new, higher position.  These internal sutures hold the tissue in place by suspending the muscles from a barb or just by passing through them.

The sagging in the forehead area is primarily caused by aging which is further aggravated by the pull of the gravity, thus leading to the formation of deep wrinkles and weakened muscles.  For this reason, most patients who ask for this procedure are between the age of 40 and 60, although some younger individuals who are genetically predispose to “facial lines” may also benefit from this treatment.

According to plastic surgeons, the primary advantage of this procedure is to make the face appear younger.  But in some cases, this is also used to correct the sad, tired, or angry expression which may affect a patient’s social interactions with work colleagues, family, and friends.

Because every patient has a varying degree of sagging, plastic surgeons are using different types of forehead lift in order to achieve a dramatic and long-lasting result.  But regardless of which surgical technique is used, doctors always prefer to place the incisions behind the hairline and/or along the natural crease of the skin (such as in front and behind the ears) so the scars are hidden.

For patients with sagging forehead and cheeks, some plastic surgeons recommend temporal brow lift which involves several incisions placed at the temples behind the hairline.  In this way, they can stretch the skin to correct the small wrinkles and folds in the forehead and lift the drooping cheek pads.

To further create a long-lasting result, some doctors perform this with suture suspension in which they use internal, permanent “support” in order to suspend the underlying tissue and muscle.

For older patients or men with thick eyebrows, some doctors in facial plastic surgery recommend direct brow lift which excises a half-moon shape of skin and muscle above the eyebrows.  However, this approach does not address the “facial lines” and wrinkles in the forehead area which makes this a less popular choice.

In case the patients have a significant sagging, the most recommended technique by experts in plastic surgery is the full coronal brow lift which involves a long incision across the crown of the head, from temple to temple.  In this way, they can remove the excess skin and tighten the muscles to smoothen out the deep furrows and small wrinkles.

The natural effects of aging also result to the formation of crow’s feet at the corners of the eyes, “frown” wrinkles across the forehead, and low-lying eyebrows.  And with such problems, it is not surprising that a person’s appearance will look tired and old.

To treat the sagginess and wrinkles in the upper facial region, plastic surgeons use browlift surgery (also referred as forehead lift) which comes in several surgical techniques since every patient has a varying level of skin droopiness and excess skin in the forehead area.

Nowadays, plastic surgeons either use the coronal procedure or endoscopic browlift to treat the sagginess in the forehead.  These techniques have their own benefits and disadvantages and patient suitability.

In coronal procedure, which is the traditional browlift technique, plastic surgeons create an incision behind the hairline that runs over the top of the head.  Through this surgical cut, they can gently pull the skin upward, including the eyebrows, in order to place this into a new, higher position.

In most cases, doctors also remove the excess fats and skin to further eliminate the sagging appearance.  At the same time, they also reshape or tighten the facial muscles responsible for the frown lines in the forehead region.

After the necessary alternations have been performed, plastic surgery specialists close the incision sites with sutures or clips before wrapping the area with a dressing and bandage.

If done properly, the coronal procedure can raise the hairline and lift the forehead of a patient.

Meanwhile, the endoscopic procedure is the second type of browlift technique in which doctors use a flexible, hollow tube with a lighted camera attached to its end.  This instrument is connected to a monitor that will guide plastic surgery specialists, allowing them to see the underlying tissues during the operation.

And since the endoscope is inserted to several small incisions behind the hairline, patients can enjoy shorter recovery, less post-operative pain and discomfort, and of course, shorter scars.

Despite the advantages of this surgical approach, this may not provide the best result for patients with a significant amount of excess skin and sagginess in the forehead region who will benefit more with the traditional browlift technique.

As with any plastic surgery, facelift requires recovery that will largely depend on the number and depth of the incisions used, and a person’s healing ability.  For this reason, individuals suffering from serious health conditions such as diabetes, excretory disorder, heart problem, delayed healing, and high blood pressure are typically considered as a bad candidate for the said procedure.

While facelift provides a satisfying result to the right patients, they should realize that this plastic surgery procedure will not change their fundamental appearance and will not stop the aging process, although it can make them look five to 10 years younger.  In general, the surgical approach provides a more dramatic outcome compared to non-invasive procedures such as botox injection, facial fillers, and laser treatment.

If needed, plastic surgeons recommend non-surgical procedures to complement facelift surgery.  Examples of these treatments include chemical peels to improve the skin texture; botox to relax the muscles and prevent wrinkles due to excessive facial movements; facial fillers or volumizers to plump up the skin and “fill in” the small crevices and hollowed areas of the face; and laser treatments to treat photo damage manifested by sun spots, freckles, and other discolorations.

Because every person has a varying degree of skin sagginess and has different locations of lines and wrinkles, plastic surgeons have developed several “isolated” techniques to remove the effects of aging.  And by specifically targeting the “problem area,” there is almost no risk of having a “windswept appearance” caused by overcorrection.

For patients aged 30 to 50, the most popular “isolated” facelift technique targets the mid face, the first area to manifest the signs of aging.  Through this approach, plastic surgeons can remove the mouth-and-nose lines, correct the downturned lips, eliminate the under-eye bags, and lift the sagging cheeks through shorter incisions made discreetly behind the hairline, along the lower lash line, or inside the mouth.

These are the other examples of “isolated” facelift surgeries: brow or forehead lift, neck lift, lower facelift, and eyelid lift.  These procedures may be combined together to create the most desired result.

However, it is important to note that most minimally invasive facelift techniques, especially if performed as a stand alone procedure, are not ideal for patients 50 years and older who will benefit more with a complete facelift.

This plastic surgery primarily aims to address these aesthetic problems: 1.) Minimize the deep creases across the forehead and between the inner corners of the eyes.  2.) Reposition a sagging brow that is hooding the upper eyelid.  3.) Raise the eyebrows to give a more alert and youthful appearance.

If needed, some plastic surgeons perform brow lift in conjunction with other rejuvenation procedures such as eyelid surgery to remove the extra skin that hoods the upper eyelid and eliminate the fats and excess skin in the lower eyelid; face lift to treat areas which have manifested the signs of aging; and skin resurfacing techniques such as laser treatment, chemical peels, and microdermabrasion.

In most cases, plastic surgeons prefer to use general anesthesia or intravenous sedation in conducting brow lift surgery.

Once the medication has taken its effect, plastic surgery specialists will create several discreet incisions within the hairline that will allow them to reposition the muscle and tissue beneath the skin and remove the furrows in the forehead.  If needed, doctors also use additional incisions in the temples and scalp to correct a low-lying brow.

In certain cases, doctors use permanent sutures, absorbable fixation device, or small surgical screws that will provide a stronger support to the new contour.

To further shorten the length of incisions, some plastic surgeons use endoscope which is a fiber-optic camera attached to a monitor.  With this instrument, patients can expect shorter downtime, minimal scarring and bleeding, less post-operative symptoms (such as swelling and bruising), and reduced risk of complications.

For patients who have severe sagginess, the endoscopically-assisted brow lift may not be a good choice.  In most cases, they will benefit more with coronal brow lift technique which uses an incision from ear to ear (behind the hairline) that will allow surgeons to lift the forehead and remove any excess skin.

But because of the length of incision, the recovery time for this approach is longer compared to the endoscopic brow lift.

Once the necessary alterations have been made, plastic surgery specialists will then close the incisions with skin adhesives, removable or absorbable sutures, special clips, or surgical tape.

Because every patient has a varying degree of skin sagginess, plastic surgeons are using different facelift techniques in order to achieve the best result with the use of the shortest incisions possible.

For older individuals, the SMAS lift and deep plane lift are the two most ideal techniques since these can access the deeper layers of the tissues in the neck and face by making a relatively long incision behind the hairline which extends in front and back of the ears.  In this way, plastic surgeons can lift the skin, reshape and tighten the tissue, and remove the loose skin that is causing the sagginess.

While these two plastic surgery techniques use the same incision site, the deep plane lift is said to provide a more dramatic result because it goes deeper into the facial tissue; for this reason, this approach also has a higher risk of nerve damage and muscle weakness.

Because of the invasiveness of SMAS and deep plane lift, these are not ideal for younger patients who can also achieve a great result even with the use of shorter incisions which may lead to faster recovery and lower risk of scarring.  Examples of these minimally invasive facelift techniques include short scar lift, endoscopic lift, mid lift, and thread lift.

In short scar lift, plastic surgery specialists create an S-shaped incision at the temple behind the hairline or in front of the ear but does not extend behind the ear.  With this procedure, they can tighten the tissue to eliminate the jowl (caused by the sagging, loose skin in the jawline) and correct the downturned lips.

However, the short scar lift does not correct the entire mid face, the area which usually manifests the first visible signs of aging.  With this, most younger patients choose mid facelift which corrects the drooping lower eyelids, sagging cheek pads, mount-and-nose lines, and downturned lips.

This less invasive facelift technique involves the use of several shorter incisions which may be placed inside the lower eyelid or in the temple (behind the hairline) and inside of the mouth, and can be done using an endoscope, a lighted camera attached to a slender probe that allows plastic surgeons to see the underlying tissue.

And lastly, the thread lift is probably the least invasive form of facelift since plastic surgery specialists do not use an extensive incision but instead some tiny suture barbs that can act as a hook in order to gather the skin layers and lift them upward, thereby creating a tighter appearance.

As with any plastic surgery, facelift involves certain risks particularly to those patients who have serious health conditions such as diabetes, high blood pressure, kidney disorder, and heart problem.  For these reasons, plastic surgeons require physical examination and consultation to determine if a person is a good candidate for this surgery.

During the consultation, plastic surgeons will evaluate the skin’s elasticity, wrinkles and folds, hairline, and facial bone structure so they can determine the best incision placement.  In most cases, they will also take some post-operative photos and ask the expectations and goals of their patients.

If the patients are cleared from any serious health conditions, they may be asked to stop certain medications particularly aspirin, certain anti-inflammatory drugs, blood thinners, and other drugs which can increase the risk of excessive bleeding.  Taking of certain supplements and vitamins should also be stopped especially if these contain green tea, omega-3 fatty acids, vitamin E, and ginko biloba since studies have shown that these may also predispose patients to increased risk of bleeding.

To be on the safe side, patients should tell their plastic surgeons about their past and present medications, medical history, previous surgeries, allergies, and other health issues that may affect the result of facelift surgery.

For patients who are smoking, they may be turned down by their doctors unless they are willing to quit the habit several months before their plastic surgery.  This is because the nicotine and other chemicals found in the cigarettes can significantly postpone the body’s healing ability by preventing the oxygen from effectively reaching the incision.  And with a delayed healing, people are more likely to suffer from skin necrosis (or death of skin tissue) which usually leads to infection and unnecessary scarring.

According to a study, smokers are 1,500 times more likely to suffer from skin necrosis after their surgery compared to non-smokers.

Aside from quitting smoking and stopping certain medications, it is also important for patients to follow their doctor’s pre-operative instructions which may include proper diet and avoidance of alcohol.

Unfortunately, there’s usually a trade off. Quick procedures that offer no, or very short, recovery times usually have results that don’t last very long.

Nonetheless, manufacturers still offer rejuvenation devices that harness various technologies like:

• Radio frequency
• Infrared
• Lasers

Usually billed as non-surgical skin tightening or non-surgical face lifts, high-tech machines, have a fairly mixed track records with patients.

For instance, RealSelf.com has 166 user reviews on radio frequency procedures; 37 percent said it was worth it.

For infrared technology, 55 percent of 22 former cosmetic surgery patients noted they were happy.

As for laser procedures, 86 percent of 15 former patients said it was worthwhile.

According to Dermatology Times, the new brow lifting technology – commercially known as the Ulthera System — uses ultrasound with a twist.

The practitioner sweeps the instrument over the treatment areas before, well, the treatment.

The machine measures the depth of the skin and delivers more heat to areas that need more tightening.

The chief investigator, Murad Alam, M.D. an associate professor of dermatology at Northwestern University, tested the device on 36 subjects.

Afterwards, Dr. Alam said the affect was more like treating the layers under the skin, and not the skin itself.

Could be.

Our concern: the last brow lift results on test subjects were made at 10 months out. However, a surgical brow lift can last five to ten years.

Also, the real test of any cosmetic surgery lies more in the art and skill of the practitioner and not the device the surgeon is holding.

Perhaps the true worth of any procedure is found in the surgeon’s before and after plastic surgery pictures, his or her level of training, board certification and what former patients say.

With tiny, lighted cables so the surgeon can see the treatment area, an endoscope has equally as small tools that grasp, move and cut structures just under the patient’s skin.

In some models, the surgeon watches what’s happening on a television monitor. Other models have an eyepiece – like a microscope – to allow for viewing.

One of the benefits is that an endoscope requires incisions that are only about the diameter of a pencil tip. This ensures quicker healing and reduces some of the risks – like nerve damage — of a longer incision.

Plus, no scars that can be seen!

Bleeding, bruising and swelling may also be reduced because fewer tissues are disturbed.

Procedures in which the endoscope can be used include:

• Breast enlargement via the TUBA (TransUmbilical Breast Augmentation)
• Forehead, or eyebrow, lifts
• Mid face lifts
• Sinus surgery

Because surgeons can work under the skin, a fixation device known as an Endotine was developed to for some facial lifting procedures.

The Endotine is a flat piece of dissolvable biomedical plastic; it holds the tissues in a higher position with small, sharp prongs. The device is about half the size of a fingernail.

For a forehead lift, the surgeon enters the arms of the endoscope through the hairline at the temples.

Using tiny screws, the surgeon affixes the Endotines to bone, lifts the sagging muscles, connective tissue and skin free from their bed, moves them up and affixes them to the prongs on the Endotine.

In six months to a year, the endotine dissolves while the lifted tissues heal back into place in the higher position.  That’s what removes deep facial folds, wrinkling and sagging.

Patients must take extra care washing their hair and applying makeup for about a month – so the lifted tissues are not pulled off the tines.

However, people with heavy brows, thin bones or allergies to plastic biomaterials would not make good candidates for an endotines brow lift.

A similar procedure is available for the mid-face, including a cheek lift.

In that use, endotines can be inserted through the patient’s mouth or through the conjunctiva, the pink area revealed when you pull down your lower eyelid.

View some before and after scarless forehead lift photos.

• Eyelid lifts
• Hair transplants
• Neck lifts

If  your favorite actress is about the same age, she has most likely had:

• Forehead lift
• Face lift
• Breast augmentation
• Lip augmentation

Somehow, TV film and movie stars, along with other celebrities seem to change appearance from one week to the next – with no hints of surgery like bruising or bandages.

If you haven’t guessed, celebrities go to great lengths to have plastic surgery in secret.
According to the British documentary, Hollywood Knives, film legend Gary Cooper wanted a face lift and checked into a New York City hospital under an assumed name for an operation on a cyst.

The next day, the hospital arranged for Cooper to leave at five in the morning and denied any plastic surgery took place.

Before that, one Beverly Hills plastic surgeon took a famous actor to his own home for recovery. But one of the surgeon’s youngsters let the cat out of the bag when he bragged at school the actor was staying at his house with a bandaged head.

News photographers were soon on the surgeon’s front yard.

But all that was in the mid-1950s, long before rejuvenation surgery became so common.

Today, with so many famous people wanting to keep their plastic surgery under wraps, top plastic surgeons offer the following safeguards from prying eyes:

• Separate waiting rooms
• Private entrances
• Assumed names so that clerks, parking lot attendants and others will be none the wiser
• Procedures taking place at 4 a.m.
• Procedures taking place on weekends
• Staying incognito at recovery centers
• Plastic and cosmetic surgeons will visit the celebrity at home or somewhere private rather than back at the practice.
• Plastic and cosmetic surgeons and their staff are committed to total secrecy

It’s a cat-and-mouse game between the news media – who often station photographers on the sidewalks outside surgeons’ offices – and the actors and actresses who want the public to think they are just blessed with natural good looks.

Which celebrity do you think has had the best plastic surgery? The worst?