Forehead and Brow Lift

In Dr. Rad’s hands, this surgery is effective in achieving the following goals: Elevating the eyebrows, Creating a natural arch and peak (for women), Creating a masculine eyebrow configuration (for men), Smoothing the forehead skin, Eliminating forehead + frown wrinkles + furrows (a “permanent Botox” effect), Elevating upper eyelid skin, Restoring eyebrow symmetry, Lowering or raising the hairline.

This option is also known as a “short incision” brow lift. Although scars are short, the technique gives excellent results with hidden scars. It is a tried-and-true approach in Dr. Rad’s hands, and he uses this technique for patients of all ages and who have a greater “lateral hooding” of eyebrow and eyelid tissues requiring greater lift than what an endoscopic approach can achieve. The method is a highly specialized technique and requires a certain level of skill to avoid visible scars and to achieve perfect symmetry. Not every surgeon is capable of performing it to Dr. Rad’s standard.

This technique is best for patients of all ages whose forehead skin is moderately wrinkled. Dr. Rad uses this technique to smooth forehead skin and to elevate the eyebrows by 2-3 mm (a modest elevation). Unlike the endoscopic approach, this surgical option is effective in smoothing wrinkled forehead skin, but is not effective in changing the position of the hairline or weakening the frown muscles. To move the hairline position back, the endoscopic is ideal, whereas to move it forward the coronal approach is best.

A Male brow and forehead lift is a procedure focused on restoring eyebrow and forehead symmetry specifically for men. The surgical approaches are unique given that the male face has different anatomy and aesthetics as compared with women.

The male forehead tends to be flatter, and the eyebrow is horizontal in shape, as compared with the upward arch of a woman’s brow. Furthermore, it should overlie the brow bone, whereas a woman’s eyebrow should rest just above it. Fullness in the lower forehead, called “frontal bossing,” is a common feature, as well. Dr. Rad pays meticulous attention to the details of the male brow so that results are optimized.

A male forehead lift should be performed only by Board certified plastic surgeons. Dr. Rad’s technique is not “cookie cutter.” Rather, he tailors his approach according to your unique anatomy and goals. Oftentimes severe asymmetry requires additional reconstructive procedures for correction. An in-person consultation with Dr. Rad is crucial to determine whether this surgery is right for you.

A gentle upward arch to the outer peak is preferred, and then slight arch downward, and the position should be at the eye socket edge (called “superior orbital rim”). Dr. Rad pays attention to these anatomical details to give each patient a harmonious result.

The ideal position is horizontal and positioned along the eye socket edge (called “superior orbital rim”). The medial (inner) edge of the brow should be aligned with the inner corner of the eye and the outer aspect of the nostril. The outer edge of the brow should be aligned with the outer corner of the eye. These alignments form a triangle that shows proper proportion with the rest of the central face.

Facelift procedures require anesthesia to ensure patients’ comfort and safety during surgery. The choice of anesthesia depends on various factors, including surgeon preference, the extent of the procedure, the patient’s health status (presence of heart, lung, kidney or endocrine illnesses), and patients’ preference. The 3 most common types of anesthesia used for facelift surgeries are:

General Anesthesia (GA)

Patients are asleep and are unaware during the surgery. During GA, the anesthesia team administers a combination of anesthetics to optimize the depth of anesthesia while minimizing side effects. This usually involves propofol for quick induction, and inhaled gas anesthetic for stable maintenance, and an array of anti- medicines to reduce nausea side effects, the most common issue with GA.

In terms of what patients experience, your last memory of the process is rolling into the OR, and then the next memory is waking up in the recovery room. You feel nothing or experience nothing of surgery. Dr. Rad’s anesthesia teams are exceptionally skilled in ensuring comfort and safety. Patients do not experience “waking up” episodes, nor do they have any memory of the procedure.

GA involves administering intravenous medications and inhaled anesthetic to induce sleep and keep the patient pain-free throughout the procedure. This involves an airway tube (“endotracheal tube”) which serves two purposes: (i) to deliver the inhaled anesthetic which gives long lasting anesthesia, and (ii) protects your windpipe preventing any fluids, secretions or phlegm from getting into your lungs which can cause a pneumonia or airways spasm/constriction (“laryngospasm”). Without protection of your airway, such as with IV sedation only, the risk of airway/lung problems is higher.

Patients awaken quickly because the depth of anesthesia is not nearly as deep as required for other types of surgery (think liver, kidney or heart surgery). Within 15-20 minutes you are awake enough to remove the airway tube, and then you are rolling to recovery. Typically patients stay for a couple or a few hours in recovery before going home.

This type of anesthesia is needed when deep plane face and neck lift with deep neck sculpting (gland reduction) is being done.

Dr. Rad advises not thinking of GA as “being on a breathing machine” or being dangerous. Rather, the anesthesia machine is supporting your natural breathing and protecting your airway. In fact, GA is for comfort and safety. In the hands of a board certified anesthesiologist (with whom Dr. Rad always works) in the safest possible environment (accredited hospital-based surgery centers) GA is very safe, in fact it is much safer than the cumulative risk of driving a car every day.

IV Sedation with Local Anesthesia

In some cases, combining sedation with local anesthesia (injected numbing medicine) is used. In this case, patients often receive propofol for the IV anesthetic to induce sedation and which helps them relax and feel drowsy during the procedure. While the patient is not fully unconscious with this approach, they are generally not aware of the surgery and experience little to no discomfort.

This does not involve the inhaled anesthetic as in GA, and does not require an airway tube. You are breathing on your own and the anesthesiologist will maintain your level of anesthesia with propofol and other IV medicines. Oxygenation is supported with supplemental oxygen.

Patients may be a candidate for this type of anesthesia for shorter procedures and neck lift that does not involve deep neck sculpting.

Local Anesthesia Only

This type of anesthesia is the simplest of all, and involves injecting numbing medicine throughout the tissues to be lifted. Dr. Rad uses local anesthetics routinely in the office and this does not require going to an OR.

We start with applying topical numbing which dulls sensation, then injected numbing medicine is given while you are awake.

Patients are candidates for this approach when undergoing in-office mini-face lifts, upper blepharoplasty, buccal fat reduction and direct brow lifts.

Overall, the choice between these types of anesthesia will be discussed during the pre-operative consultation with the surgeon. The surgeon will consider the patient’s medical history, the complexity of the procedure, and the patient’s preference when deciding on the appropriate anesthesia.

You may hear that the safest plastic surgeons have “operating privileges” at major hospitals. “Operating privileges” allow surgeons to perform surgery at that hospital, and they are granted following a 6-month process of evaluating a surgeon’s background.

Dr. Rad’s credentials have rigorously been vetted by the top hospitals in DC and northern Virginia, specifically Sibley Hospital (DC), Inova Fairfax Hospital and Fair Oaks Hospital (northern VA), and George Washington University Hospital (DC). This means that his training, board certification and safety record meet the high standards of these top hospitals in DC and northern Virginia.

Dr. Rad performs corrective work on patients treated elsewhere and who’ve had unsatisfactory results. If the eyebrows are over-elevated, or asymmetrically elevated, then a number of problems can arise. The most common problem is a “surprised look.” This is caused by exuberant release of the entire forehead tissues and uneven tension when the forehead is lifted. Dr. Rad avoids this by precisely controlling the degree of tissue release and tension. When he corrects this problem caused by another surgeon, he reverses the pull on tissues in order to restore normal shape. Other problems that can arise is an angry look or the “Spock brow” caused by over-elevation of the outer brows. This can be a challenge to fix, but Dr. Rad has addressed this by releasing the inner aspect of the eyebrows. Finally, a sad appearance can occur when the inner brow is higher than the outer brow. This is caused by exuberant release of the inner brow tissues and inadequate release of the outer tissues. This is a common error amongst inexperienced surgeons and which Dr. Rad has extensive experience treating. To correct this, the doctor evaluates the overall position of the brows: if too low, then elevating the outer area is the approach; if too high, then lowering the inner position is effective.

Experience is key: as a Board certified plastic surgeon, Dr. Rad has performed thousands of facial cosmetic operations and while Director of Aesthetic Surgery at Johns Hopkins Dr. Rad instructed surgeons-in-training in complex surgical techniques. During your consultation, the doctor performs a detailed evaluation of your anatomy, both at rest and during animation (i.e. while engaging in conversation), with precise measurements, photography and aesthetic judgment. Together with you, Dr. Rad customizes a highly specific operative plan to achieve the most harmonious, natural results with minimal down time. If you’ve had prior suboptimal results then you’re in the right hands: Dr. Rad routinely performs corrective work on patients who seek his experience following poor results performed elsewhere.

The eyebrow and upper eyelid are intimately related, and for optimal aesthetics, it’s important to address both. If the eyebrow is in a properly elevated position with arched contour, and upper eyelid skin excess is a concern, then upper blepharoplasty is indicated. If the eyebrows are low, then excess upper eyelid skin may be relieved partially or completely with the forehead lift procedure. If excess upper eyelid skin is only partially relieved by forehead lifting, then combining the two is best. Keep in mind that correct diagnosis is essential and the right approach requires in person evaluation with Dr. Rad.

The cost of a brow lift in Washington, DC, depends on many factors: the type of forehead lift, whether it is performed in-office or in a hospital-based OR, and the quality/skill of the surgeon. At Dr. Rad’s practice, the price of forehead lift surgery ranges from $5,500 for an in-office direct brow lift to $25,000 – $35,000 for endoscopic, coronal brow lift or forehead reduction, and up to $50,000 for corrective work. While total cost increases when combined with other procedures, surgery is cost-effective when multiple procedures are combined. Cost is a reflection of the skill and experience required to obtain excellent results. Under our care, your experience is guaranteed to be the highest quality.