#22 Forehead Lift Revision Surgery: When is it Possible and How Much Can Be Restored?

Forehead lift revision surgery is a highly complex procedure that requires re-evaluation when the initial results are unsatisfactory due to insufficient temporal dissection, fixation failure, inadequate ligament release, or when overcorrection causes discomfort. It is crucial to precisely identify the eyebrow, forehead, and temporal ligament structures to thoroughly diagnose the reason for and feasibility of revision surgery. Depending on the skin laxity, scarring, and adhesion status, a customized approach is possible, ranging from re-lifting the eyebrows (revision forehead lift) to restorative surgery to correct overcorrection. This article details the principles of forehead lift revision surgery based on practical cases, including when revision is necessary, when it is difficult, the principles of overcorrection restoration, and combined surgeries with hairline advancement, sub-brow lift, or blepharoplasty. It also includes professional content on anatomy, dissection range, fixation points, and scar management, which are essential for a successful forehead lift. – Dr. Kim Sung-hoon, SH Plastic Surgery, Face Designer

In my previous article, I stated,

‘The biggest reasons for forehead lift surgery failure are insufficient temporal dissection and fixation failure.’

The forehead and eyebrows move as a single unit, including the temporal region.

If the temporal ligaments are not sufficiently released and not firmly fixed to the deep temporal fascia,

the eyebrows may lift temporarily and then descend again within 3 to 6 months.

At this point, patients often ask a common question:

‘Doctor, does that mean if a forehead lift goes wrong once, it's over?’

Today, I will answer this question under the topic of

‘Forehead Lift Revision and Restoration Surgery.’

1. Is Forehead Lift Revision Surgery Really Possible?

In short,

‘Forehead lift revision surgery is definitely possible.’

Except for special exceptions,

there are no absolute rules against performing forehead lift revision surgery.

However, it requires considering many more factors than the initial surgery,

and it involves calculating tissue damage, scars, and skin laxity,

making it a more challenging procedure.

Revision surgery is usually needed in three cases:

① Insufficient Effect

When there is minimal change after surgery,

or when the eyebrows lifted slightly initially but descended again within a few months.

In these cases, as mentioned earlier,

the cause is often insufficient temporal dissection, inadequate ligament release, or fixation failure.

② Overcorrection – ‘Surprised Rabbit Eyes’

When the eyebrows are excessively lifted, making the forehead always appear surprised,

or when lagophthalmos (incomplete eyelid closure) occurs, preventing the eyes from closing completely.

In this case, it’s not a revision surgery to lift further,

but rather a ‘restoration surgery’ to lower the eyebrows.

③ Revision Due to Aging

When 5 or 10 years have passed since the first surgery,

and the forehead and eyebrows have gradually descended again.

Another correction can be considered naturally as part of the aging process.

Most patients can undergo revision surgery about 2–3 times throughout their lives.

Of course, achieving the longest-lasting results with a single surgery

is ideal for both me and the patient.

2. So, When is Revision Surgery Difficult?

Not all revision surgeries are possible.

Careful judgment is required in the following cases:

① Insufficient Skin

If too much skin was pulled during the first surgery,

preventing the eyes from closing properly,

or if further lifting is expected to definitely cause lagophthalmos.

In this case, ‘further lifting revision surgery’ is not possible.

Instead, restoration surgery to lower the eyebrows should be considered.

② Severe Scars/Adhesions Limiting Movement

If the forehead and eyebrow area are hardened due to previous surgery,

and do not move well when touched by hand.

In such cases,

even if the internal scars are sufficiently dissected and removed,

movement may be limited,

and the effect of revision surgery might be partial.

Before surgery, it is essential to

directly touch the eyebrows,

pull the forehead,

open and close the eyes, and make facial expressions

to comprehensively evaluate skin laxity, elasticity, and scar location.

3. How Many Times Can a Forehead Lift Be Done in a Lifetime?

I often receive this question too.

‘Doctor, I heard a forehead lift should only be done once in a lifetime?’

The answer is this:

Theoretically, multiple revision surgeries are possible.

However, considering skin laxity, scar condition, and tissue damage,

realistically, 2–3 times is a safe upper limit.

That's why I always say:

‘More important than the number of surgeries itself is whether the initial surgery was right for your face.’

If the indications are incorrectly set from the beginning,

it is difficult to increase satisfaction even with repeated revision surgeries.

4. Surgeries to Consider in Conjunction with a Forehead Lift

Forehead lift revision surgery doesn't

always focus solely on the forehead.

The overall impression of the upper face must be considered.

① Forehead Reduction Surgery (Hairline Advancement)

For individuals with a very wide forehead,

a forehead lift might create an illusion of an even wider forehead.

In such cases, combining it with forehead reduction surgery by advancing the hairline

can achieve a more harmonious result.

② Double Eyelid Surgery (Upper Blepharoplasty)

While a forehead lift improves eyebrow position,

it doesn't necessarily correct all double eyelid asymmetries or line shapes.

If a symmetrical impression is desired,

double eyelid surgery may be considered simultaneously.

③ Upper Eyelid Fat Grafting

When the eyebrows are lifted with a forehead lift,

upper eyelid hollowness may become more prominent.

In this case, supplementing volume with upper eyelid fat grafting

can create a much softer impression.

5. Key Considerations for Forehead Lift Revision Surgery

① Incision Site Selection

If there is severe

hair loss,

thick scarring,

or adhesion

at the existing incision site, rather than using the same spot,

scar revision or a new incision location may be chosen.

② Scars Acting Like ‘Retaining Ligaments’

After the initial surgery, scar tissue sometimes holds the eyebrows in place

instead of anatomical ligaments.

In this case, it's not the original ligaments but

the ‘scars acting as false ligaments’ that need to be released

for the eyebrows to move naturally again.

③ Risk of Overcorrection

Sometimes, patients request, ‘Please lift it more strongly this time,’

because the previous effect was insufficient.

However, without considering skin elasticity, laxity, and eye closure,

excessive lifting can lead to problems such as

a surprised expression

or impaired eye closure.

For revision surgery, it is crucial to accurately calculate the ‘limit of how much can be lifted.’

6. Revision Surgery to Lift Eyebrows vs. Restoration Surgery to Lower Eyebrows

Forehead lift revision surgery can be broadly divided into two types:

① Revision Forehead Lift to Re-lift

When the effect is insufficient

or the eyebrows have descended again over time.

→ This surgery involves extending the dissection range to the temporal area,

sufficiently releasing the ligaments,

and firmly fixing them to the deep temporal fascia

to re-lift the eyebrows.

This is considered a relatively less difficult surgery.

② ‘Restoration Forehead Surgery’ to Reverse Overcorrection

When the eyebrows are excessively lifted, making the face always appear surprised,

or when there is lagophthalmos, preventing the eyes from closing completely.

In this case, surgery to lower the eyebrows is necessary.

If forehead reduction surgery, which involves tissue removal, has already been performed,

the difficulty increases significantly.

Because it requires simultaneously performing all these processes:

wider dissection range,

resolution of scars and adhesions,

and repositioning of remaining skin and tissue,

it is considered ‘a much more difficult surgery than re-lifting.’

In actual cases,

pre-operative photos show a constantly surprised expression

and lagophthalmos when the eyes are closed, but

after restoration surgery, the eyebrow position naturally lowers,

and the eyes can close comfortably.

Dr. Kim Sung-hoon, Face Designer's Reflection

Forehead lift revision surgery is

not just a matter of ‘should we lift a little more or lower it?’

It involves simultaneously considering anatomy, function, and aesthetics:

how much skin remains,

how much the forehead and eyebrows move,

what scars are holding them internally,

and where the temporal ligaments and fixation points are.

The best scenario is to avoid revision surgery altogether.

To do that, from the very beginning,

you should consult thoroughly with a board-certified plastic surgeon,

‘Do I really need a forehead lift?’‘If so, what extent is appropriate?’

You need to find the answers to these questions first.

If you have already had a forehead lift

but the effect is unsatisfactory or you experience discomfort due to overcorrection,

I recommend not agonizing alone but getting a direct examination of your actual eyebrow, forehead, and eye closure status.

At SH Plastic Surgery,

I will continue to work with each patient

to find the most natural and comfortable position for their forehead and eyebrows.

A forehead lift without revision failure,

begins with accurate diagnosis and thorough consultation.

You can find more detailed explanations on YouTube via the link below ^^

SH Plastic Surgery Clinic