Forehead Rejuvenation Surgery

Q: Dr. Eppley, I am interested in forehead rejuvenation surgery. First, I have deep horizontal wrinkles across my forehead and vertical wrinkles in the corrugator area. These wrinkles have been effectively controlled with Botox for many years. The only thing is that if Botox is not done properly, I get pointed eyebrows and a Spock type look.  This is the reason why I’m interested in a brow lift and corrugator resection – to eliminate the wrinkles, precisely place the eyebrows, while providing a more permanent solution to the wrinkles.

On top of the wrinkles caused by my powerful brow muscles, I have numerous shallow boxcar acne scars in the upside down triangle area of my corrugator area (with the apex of the triangle meeting with the bridge of my nose directly between my eyes).

Several years ago I had fat grafting to the entire forehead and for a while (due to both the fat graft and swelling from the procedure) all of my forehead issues, including the boxcar scars, were greatly smoothed out. But the swelling went down and my powerful forehead muscles eventually eliminated the fat that was grafted. This is why when I saw that you do forehead implants, I got interested.

My hope would be that a properly placed forehead implant would have the same effect that the fat grafting/swelling initially did from the fat grafting procedure, which was to raise and stretch to skin thereby smoothing the scars.

A: Thank you for the forehead rejuvenation surgery clarifications and let me provide some commentary about them.

1) A brow lift is not a cure for horizontal forehead wrinkles. Its effect is that of a brow lift not a wrinkle reducing operation. There is no surgical equivalent to what Botox does in terms of muscle deanimation. While it may have some temporary benefit in terms of lessening the depth of the wrinkles, it is most certainly not a permanent solution for them. (for which there is none) One undergoes a browlift for the goals of lifting the brows as that is the one assured benefit of the surgery.

2) Corrugator muscle resection through an upper blepharoplasty is best approach to do it, not through a superior browlift. Again it will help with the glabellar furrowing but it will not completely eliminate the furrows and it is not a permanent cure or solution to them.

3) A forehead implant will help stretch out the skin and provide some smoothing effect. But this is completely dependent on its size and thickness and there is a delicate balance between forehead implant that provides the best smoothing effect and one that makes the forehead look too big.

Dr. Barry Eppley

Indianapolis, Indiana