Last updated: 02/17/2009

Diagnosis

It is somewhat misleading to speak of diagnosis on the context of forehead lifts and similar procedures because cosmetic surgery is unique in one respect—it is the only type of surgery in which the patient initiates "treatment"...

rather than the doctor. This difference means that many plastic surgeons now screen patients for psychological stability as well as general physical fitness for surgery. Beginning in the 1970s and 1980s, psychiatrists began to see patients who were obsessed with a particular facial feature or other small part of their body, as distinct from overconcern about weight or general body shape. This condition, which is now called body dysmorphic disorder (BDD), became an official psychiatric diagnostic category in 1987. Patients with BDD frequently seek plastic surgery as a solution for their dissatisfaction with their looks. In many cases, however, the "flaw" that the patient sees in his or her face is either exaggerated or nonexistent. Ironically, although men are less likely than women to request facial surgery, a higher percentage of male cosmetic surgery patients are emotionally disturbed; one survey of plastic surgeons estimated that six out of every 100 female patients and seven out of every 100 male patients meet the diagnostic criteria for BDD.

When a person consults a plastic surgeon about a forehead lift or similar procedure, the doctor will spend some time talking with the patient about his or her motives for facial surgery as well as taking a general medical and surgical history. Good candidates for facial surgery are people who have a realistic understanding of the risks as well as the benefits of this type of surgery, and equally realistic expectations of the outcome. On the other hand, the following are considered psychological warning signs:

• The patient is considering surgery to please someone else, most often a spouse or partner.
• The patient expects facial surgery to guarantee career advancement.
• The patient has a history of multiple cosmetic procedures and/or complaints about previous surgeons.
• The patient thinks that the surgery will solve all his or her life problems.
• The patient has an unrealistic notion of what he or she will look like after surgery.
• The patient seems otherwise emotionally unstable.

If the surgeon thinks that the patient is a good candidate in terms of motivation, he or she will continue the diagnostic assessment by examining the patient's face at close range. To make an initial evaluation of the possible results of a forehead lift, the surgeon will gently lift the skin at the outer edges of the eyes above the brows in an upward direction. He or she may also ask the patient to look in a mirror and describe what they don't like about their face. Next, the surgeon will ask the patient to frown, smile, or make a variety of other facial expressions. This technique allows the surgeon to observe the activity of the patient's facial muscles. Depending on the amount of loose skin in the upper eyelid, the height of the patient's hairline, and the relative position of the eyebrows, the surgeon may recommend a blepharoplasty or other procedure instead of a forehead lift.

Preparation

Preparation for a forehead lift involves practical as well as medical concerns.

FINANCIAL CONSIDERATIONS. Most cosmetic facial procedures are not covered by health insurance because they are regarded as nonessential elective procedures. As a result, many cosmetic surgeons request that fees be paid in full before the operation. According to the AACS, 13.4% of cosmetic surgery patients take out loans to finance their procedure. In 2002, the average cost of a forehead lift was $3300.

MEDICAL AND HOME CARE ISSUES. A patient scheduled for a forehead lift will be asked to prepare for the operation by quitting smoking and discontinuing aspirin or any other medications that thin the blood. The surgeon will ask for a list of all medications that the patient is taking, including alternative herbal preparations as well as prescription drugs, to make sure that there will be no interactions with the anesthetic.

Patients are advised to have someone drive them home after the procedure and help them with routine chores for a day or two. If the forehead lift is combined with a face lift or blepharoplasty, the surgeon may have the patient remain in the hospital overnight. Although cosmetic surgery on the face does not interfere with walking or routine physical activity, most patients tire easily for the first few days after the procedure.