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The face is the most visible determinant of an individual’s perceived age. A youthful forehead is characterized by smooth skin devoid of wrinkles or pigmentary changes, a short hairline-to-eyebrow distance, well-positioned eyebrows and well-contoured temples.
In women, the eyebrows lie just above the upper margin bony eye socket and form a gentle arch or upward slope toward the lateral (outer) sides. In men, the eyebrows lie at the upper margin of the eye sockets and are normally flat.
Aging changes in the forehead start to manifest in the third decade of life. Forehead wrinkles manifest as horizontal forehead lines and may be dynamic (appears intermittently) or static (permanently present). These add to a person’s perceived age. Other visible aging changes include a receding hairline, frown lines, irregular forehead contour, low-lying eyebrows, upper eyelid hooding, and hollow temples. The eyebrow shape changes with age as well.
With advancing age, the inner (medial) portion of the eyebrow is raised and the outer (lateral) portion drops, resulting in a downward slope. Individuals with aged upper faces are often described as angry, frowning, or appear tired.
Forehead wrinkles arise from two processes occurring simultaneously: laxity of the forehead and/or upper eyelid skin, and gradual loss of the forehead subcutaneous fat. With advancing age, the skin becomes thin and loses elastin and collagen fibers and becomes lax. The skin droops downwards into the upper eyelid region and eventually causes partial obstruction of the visual field.
Consequently, the individual subconsciously elevates the eyebrows with the forehead (frontalis) muscles to relieve the visual field obstruction. Long-term hyperactivation of the frontalis muscles results in these horizontal forehead lines.
There is also reduction of thickness of the subcutaneous fat layer between the skin surface and the forehead muscles. The fibers of the forehead muscle are inserted directly into the skin and its action becomes more prominent. The result is the appearance of horizontal forehead lines.
Females tend to develop multiple shallow forehead wrinkles, whereas men have few but deep forehead wrinkles. This is due to inherent anatomical differences in the muscle structure: women tend to have thinner and weaker forehead muscles, whereas men tend to have thicker and stronger muscles. These anatomical differences affect treatment planning between the two genders.
The optimal treatment for forehead wrinkles depends on the severity and the individual anatomy. There are two possible treatment methods: botulinum toxin injection, and brow lift. Both are effective and safe treatments in experienced hands. Successful forehead rejuvenation relieves upper eyelid obstruction and benefits the overall aesthetic. It improves self-confidence and social functioning.
Forehead wrinkles are reliably treated with botulinum toxin injection and attains a high degree of satisfaction in most cases. The popularity of botulinum toxin injection has grown rapidly since the 1990s, and it is now one of the most commonly administered procedures in the world. A detailed explanation of botulinum toxin treatments may be found here.
Individuals with shallow, dynamic wrinkles with minimal skin laxity are suitable for botulinum toxin injection. Botulinum toxin injection does not reverse forehead skin laxity.
Botulinum toxin causes partial weakening of the frontalis muscle that is involved in the formation of horizontal forehead wrinkles. The number of injections and the dose per injection point are determined by individual anatomy and the gender. Males generally require higher doses of botulinum toxin for optimal result. Injections are usually avoided in the lower forehead to prevent eyebrow drooping, which will lead to an angry or tired appearance.
The effects of botulinum toxin take 1 to 3 days to be observed, and will last for 4 to 6 months. Repeat treatments are necessary for maintenance of the result.
Individuals are advised to avoid vigorous massage to the treatment area for 2 hours following the injection. This is to prevent spread of the botulinum toxin, which may result in potential unintended adjacent muscle paralysis. Individuals may resume their usual activities immediately following the procedure.
Brow lifts are the most comprehensive method of addressing the components of forehead aging and produces exquisite, bespoke and sustained forehead rejuvenation. Brow lifts are ambulatory procedures performed under intravenous sedation or a short general anesthesia.
Individuals with forehead skin laxity, elongation of the forehead height and deep horizontal forehead skin creases are good candidates for brow lifts. Individuals who have had suboptimal result with botulinum toxin injection may consider brow lift surgery. Botulinum toxin injection does not reduce forehead skin laxity.
Brow lift surgery delivers sustained reduction of horizontal forehead wrinkles, elevation of eyebrows to their natural position (at or above the bony eye socket) and restoration of an aesthetic brow shape. Men generally have eyebrows that are horizontal, whereas women tend to have eyebrows that are gently upward sloping or arched. Brow lift surgery also reduces excess forehead height if present. The scars are well-concealed within the hairline.
Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.
An incision is usually made behind the hairline, and the forehead skin and muscle is elevated from the underlying forehead bone. The eyebrows are fixed in the correct position, and the excess skin and muscle removed. Skin closure is also performed in a meticulous manner to optimize wound healing and camouflage its final appearance.
Dr Matthew Yeo is experienced with surgical brow lifts and incorporates proprietary techniques to deliver exquisite and sustained results while minimizing the postoperative recovery time.
The initial skin incision is performed using a special angled technique for preservation of the hair follicles, so that hair will eventually grow through and camouflage the scar. A special wound closure technique is used to optimize the final postoperative scar appearance.
Our Singapore plastic surgery clinic has an en suite operating facility, which assures your maximal privacy and convenience, and keeps facility and equipment costs contained. Our operating room carries a full range of equipment tailored for brow lifts.
Mild bruising and swelling is expected, which will mostly resolve by the 10th postoperative day. The swelling is often more visible in the upper eyelid region than in the forehead because the eyelid skin is thinner. Stitches are removed on the 10th postoperative day and most individuals are able to return to work by then.
Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Gentle hair washing is possible from the second postoperative day onwards. Strenuous activity should be avoided for the first two weeks to minimize bruising.