Endoscopic Forehead Lift - Complications
- Inadequate lift requiring a second procedure. While overcorrection is unusual using the endoscopic technique, undercorrection can happen. Sometimes the brows descend again and can benefit from another lift. Sometimes this happens within a few years. Fortunately, it is possible to revise an endoscopic forehead lift using the same small incisions, so there are no new scars. The surgery and recovery tends to be no more difficult than the first operation.
- Hair loss ("alopecia") at scalp wounds. A period of six months is allowed for hair regeneration in the area of the scars. If there is still a noticeable bald area, the scar is revised under local anesthetic in the office. The small patch of bald scalp is removed and the hair-bearing edges brought together to make the scar as inconspicuous as possible
- Persistent frown lines. The corrugator muscles are remarkably resilient. It is important to realize that this procedure is likely to weaken the muscles causing frown lines but not totally inactivate them, which would be undesirable anyway. Persistent frown lines can be treated with Botox and a filler such as fat can be used to treat deep creases. Just because a patient has had a forehead lift, this does not mean that they won't benefit from maintenance later using these minimally-invasive techniques.
- Over-dissection of corrugator muscles. Sometimes surgeons, in a well-intended effort to eliminate frown lines, remove all the corrugator muscle they can see. The problem is that this may produce a depression of the area between the eyebrows ("glabella") due to tissue loss below the skin, and may even cause the eyebrows to drift apart due to the loss of traction medially on the brows. The experienced plastic surgeon learns to strike a balance between weakening these muscles by teasing them apart, and excision, which might produce these secondary problems.
- Asymmetry. A unilateral lift (left or right side only) may be recommended for existing eyebrow level asymmetry. This asymmetry is brought to the patient's attention before surgery. Often both sides are treated and the plastic surgeon elevates the brow more on the lower side.
- Frontal nerve weakness. The frontal nerve may be traumatized. However, this is typically a result of stretching from a facelift done simultaneously rather than the forehead lift.
- Scalp numbness. There is always some degree of scalp numbness from division of small sensory nerve branches. The major sensory nerves, the supraorbital nerves, are well-seen during the procedure. This visualization reduces the risk of injury to the supraorbital nerves. The small supratrochlear nerves are also visible. They are small enough to be of little consequence.
