Forehead Lift

Almost everybody gets laxity of forehead and drooping eye brows due to aging. This commonly starts at the age of 45 years.

Some patients can get laxity of forehead and drooping eye brows due to genetic reasons in their twenties and thirties.

FIGURE 67-1 Three different types of esthetically pleasing foreheads and eyebrow position. The tail of the eyebrow is located along the alar-canthal line. The greatest brow arch is seen in the lateral third between the lateral limbus and canthus of the eye. The outer half of the brow is “ideally” located 5 to 10 mm above the orbital rim in females.

Ideal size of the forehead should be one third of the overall facial height.

Coronal Forehead and Brow Lift

Traditionally performed with incision of entire forehead from ear to ear. Serious side effects can occur due to deep dissection. A very long incision is made which means a great amount of tissue damage which can permanently increase aging. With frontalis muscle resections strange facial expressions can occur.  Damage to the lateral frontalis muscle can cause nerve damage causing ptosis (Closure of eyes with drooping eye brows) and other irregularities. Swelling after surgery can be severe and because of the lengthy scar hair loss occurs post operatively. There can be permanent anesthesia of the scalp as well as significantly elevated hair line.

The brwo lift does not correct the loss of tissues and fat which occur as a result of natural aging. It stretches the structures to compensate for the tissue loss.  With my technique of fat grafting with forehead lift there are no side effects mentioned above.  The skin and wrinkles of the forehead correct easily. Hair growth is increased due to the inceasing of the blood supply which occur due to the fat grafting.  Not to mention excellent improvement of the skin color and tone which occur due to the stem cell replacement.  Results are much longer lasting and further improvements can be obtained with repeat fat grafting which provides even better results. This is in contrast to cutting brow lifts which each subsequent cut damages tissues further and causes more severe scarring leading to increased aging.

Trichophytic technique of forehead lift is another traditional technique where the surgeon makes the incision behind the hair line. The extra skin is excised lifting the eye brow and shortening the forehead. With pretrichial lift the incision is placed in front of the hair line. With both techniques a visible scar is the biggest side effect. Same side effects mentioned with the coronal lift with increased aging and hair loss occur in the long run.

Endoscopic Forehead and Brow Lift

Initially started a century ago with Nietze's description of a crude cystoscopy. This technique got popular in 1990s. Several incisions are placed behind the hairline and the endoscope is placed for blunt dissection.

Endoscopic brow lift in progress.

Main advantage is not having a long incision scar. Still with blunt dissection and fixation to the bone blood supply is compromised and these patients age faster after the procedure.  If corrugator and procerus muscles are removed bizaare facial expressions and glabellar depression can occur.  Dissection over the temporal crest can cause damage to the temporal nerve.

Direct Brow lift

Skin excised over the eye brows directly. permanent scar remains visible over the eye lid.

Complications of the traditional brow lift include poor scar appearance, wound dehiscence, hematoma, skin necrosis, asymmetries, sensory nerve damage, paralysis of the face, eyelid ptosis, corneal abrasions, dry eye syndrome, hair loss, infection, relapse, irregular facial expressions and contour abnormalities.  Facial paralysis and major tissue loss occur in 3 in 1000 patients.

Permanent hair loss is very common with all techniques of traditional brow lift. Numbness of the forehead is also very common.

Now we introduce the wonderful antiaging technique of fat grafting with Dr Nimal Gamage's Unique Technique

P Fat Grafting done early in life before ageing is advanced with provide antiaging so you can prevent all these unnecessary surgeries later in life which actuallly increase your ageing.

1. blepheroplasty.  This is where excess skin is removed from upper or lowe eyelid.  The problem here is that the patient may actually look older and will age faster after the surgery.  Fat grafting into the under the eye and lateral eye region and to the eye lids to lift them early in life will totally prevent aging in this area. Patients can maintain the results with the antiaging diet, laser treatments and glutathione injections and leading an antiaging life.

2. Forehead lifts

What is actually requires is fat rejuvenation of the entire forehead. This can be done in a few hours using the patients unwanted storage fat from abdomen, lower back, upper back, under arm or thighs.  The stem cells present in the storage fat will provide years of antiaging and slow down further ageing of the area.

3. Collagen, restylane perlane, silicone or other filler injections. These are a total waste of money and time.  Side effects include unnatural look, bumps, and increased aging due to the damage which invariably occur to the normal circulation around these injections.  When fat with stem cells are used the circulation grows into the fat graft thereby increasing the total blood circulation of the area. The resulting natural antiageing of the skin can be seen for years to come.  Only side effect is when you choose an inexperienced doctor who has just started doing these procedures and obviously do not know how to perform it properly.

4. Face lifts and neck lifts

Anytime you cut skin off of the face or neck that area will age much faster in the years to come. It is much better to handle lose skin with lasers, dermapen treatments and fat grafting to obtain a very natural antiaging effect.

Patients should definitely be on Nimal Diet as explained in my book " Secreats of everlasting youth"

They should be on a program of laser treatments to the face and neck regularly and antiaging creams and antiaging glutathione injections.

Sun should be avoided with umbrellas or avoiding exposure to direct sun altogether by changing your life style.

Alcohol and smoke should be avoided completely.

No sleepless nights where people get together for parties and break sleep and abuse their ears with loud music thinking that they are actually entertaining themselves. 

Above picture shows a patient with advanced aging of the forehead  and drooping eye brows and pronounced under the eye aging with eye bags, deep nasolabial folds with dropping of the corners of the mouth and loss of volume of the chin.

All these are corrected with fat grafting done to forehead, around the eyes, over the nasolabial fold, around the mouth, to the chin. The patient looks 20 years younger after two fat grafts. The look is very natural and there were no side effects what so ever.  Furthermore if she were to spent money on fillers to obtain this kind of rejuvenation she would have spent about 20 times more money without getting the long lasting natural look she got now. Filler would have gone away completely in 6 months subjecting her to increased aging due to the damage to her skin.

Above is a patient I had performed a fat graft about 10 years ago when I was practcing in California.  She had total dropping of her face, pronounced nasolabial folds, deep marionette lines, loss of chin and bigger looking nose due to loss of tissues from her cheeks.  The picture on the right shows how the fat grafting has given her a lift of the entire face without any cuts or threads. She looked much younger and prettier as well. I must say that my current techniques are about 10 times more advanced and at that time I did not perform forehead lifts which I do now.

AAbove is a patient who had fat grafting to her face in two occasions and proves that fat grafting actually make your face thinner with the uplifting of the cheeks and extension of your chin.  It also makes your nose much more attractive.  You can see how her nose appears smaller on the right side after two fat grafting to her cheeks and lip enhancement with fat grafting. A woman's or a man's nose always starts to look bigger as the aging takes away your cheeks. some people experiece this early in their lifes.   Most of them end up going for nose jobs which does not make them prettier and are full of complications.  Micheal Jackson who had a prettiest nose was so obsessed with getting a small nose. Unfortunately his plastic surgeons did not have the wonderful technique of fat grafting at that time. His face was ruined by cutting surgeries and several rhinoplasties so he had to resort to wearing a prosthesis on the nose during his later life.  One must always consider a fat graft to correct the aging of the cheeks before they even think about a Rhinoplasty. ( Nose Job)

Above is a good example of going from pretty to spectacular with fat grafting technique. Premature aging due to being overweight is obvious on the left picture where she had excess fat in the chin and jowls and the lower face which were removed. Her nose looks bigger on the left and looks cute and small on the right. this was due to the fat grafts to the cheeks.  She now has fuller and more natural lips on the right and her small chin looks prettier and more proportionate on the right.  This is proof that you can lose weight and still look better and younger if the fat grafting is done prior to losing weight. Most people lose weight with diet and exercise but look older and uglier afterwards  One must never put collagen, restylane, silicone or other fillers in their lips becuase they give you sausage lips which look unnatural. Fat is the only thing you want for a lip augmentation if you want it to last and provide you with such a natural augmentation that most people would not know you had anything done on your lips. .