Doctor's Column

Forehead lift surgery (Endoscopic Brow Lift / Forehead Lift) is one of the facial lift procedures that has increased most rapidly in Asian countries, including South Korea, Japan, and Thailand, during 2024–2025. It can simultaneously resolve drooping eyelids, brow ptosis, forehead wrinkles, and heaviness in the upper face, and interest has surged as it has been promoted as a "surgery that brightens the eyes without having to undergo eye surgery." However, in actual clinical practice, not a few patients feel that they "saw no results at all" or that "nothing has changed from before," despite having undergone a forehead lift. Dr. Kim Sung-hoon, Director of SH Plastic Surgery, finds the reasons in anatomical factors such as the eye-opening muscle (levator), skin thickness, ligament structures in the temple area, dissection range, and fixation failure. In this article, we have compiled the principles of a forehead lift, the three key reasons for not seeing results, situations where revision surgery is needed, and even self-diagnosis methods that patients can actually check themselves. This will serve as the most practical guide for those considering a forehead lift or those who have not achieved their expected results after surgery.

Face Designer, Dr. Sung-Hoon Kim, Director of SH Plastic Surgery

"Why did I not feel any effects from the forehead lift?"

There are quite a few people who come to the consultation room with this question.

"Doctor, I had a forehead lift... Why can't I see any difference at all?"

Even when forehead lifts were spreading like a trend,

the misconception arose that "anyone who gets it done will have their eyes opened wide."

However, a forehead lift is not a cure-all surgery,

and depending on specific anatomical conditions, it may produce no effect at all.

I would like to summarize the reasons why a forehead lift might not be effective

into three anatomical categories.

1. When the eye-opening power (Levator) is weak — "If you only lift the forehead, you actually look sleepier"

A forehead lift is not a surgery that directly enlarges the eyes.

It is merely an indirect effect that "secures room in the eyelid skin" by lifting the eyebrows.

But what happens if someone with a weak eye-opening muscle (levator palpebrae superioris) only lifts their forehead?

The distance between the eyes and eyebrows widens,

and since the eyelid opening remains the same,

a phenomenon occurs where you actually end up looking sleepier.

In other words, if there is ptosis or a lack of eye-opening strength,

a forehead lift alone is ineffective.

What is the solution in this case?

Ptosis correction, which reinforces eyelid strength first, should be the priority.

2. In cases of significant skin sagging (skin redundancy) — "No change unless the excess skin is directly excised"

A forehead lift is a surgery that repositions the skin upward;

it is not a surgery that reduces the amount of skin.

Therefore, it is less effective under the following conditions:

The skin is thick,

the amount of excess skin is large,

and eyelid sagging is severe.

In such cases, no matter how much you lift the forehead

Because the excess skin continues to droop and cover,

the eyes do not look refreshed.

What is the solution?

Direct excision surgeries such as sub-brow lift (direct skin excision)

or incisional upper blepharoplasty (skin excision) are necessary.

3. Problems with the surgical technique itself — “Insufficient dissection + Insufficient ligament release + Fixation failure”

I consider the most common cause of failure in a forehead lift to be

“insufficient temple dissection.”

The reasons are as follows.

The forehead moves in connection with the temple region.

Strong ligaments that pull the eyebrows down (such as the orbicularis retaining ligament)

exist in the temple area.

These ligaments must be released for the eyebrows to truly lift.

Insufficient dissection area → Forehead does not lift

If only a small portion of the forehead is dissected,

or if the ligaments in the temple area are not released,

the eyebrows will never lift.

If the fixation is weak, it returns to the “original position” over time.

If not properly fixed,

it drops within 3 to 6 months, “returning to the pre-operative state.”

In other words,

Indirect effect + Delicate dissection + Reliable fixation

Only when all three of these align is it a true forehead lift.

This layer is a very tough and strong fibrous tissue.

It is used as the most stable anchor point in an endoscopic forehead lift.

In the illustration, the suture is anchored to the deep layer →

This means that after lifting the eyebrow, it is firmly fixed to this layer.

This is precisely:

the principle behind “The reason the eyebrow lift lasts long = Deep temporal fascia fixation,”

and why the temples must be dissected.

Self-diagnosis method to check for yourself

"Will a forehead lift be effective for me?"

1. Try opening your eyes while completely relaxing your eyebrows.

→ If your eyes look dim and heavy at this moment

= Insufficient eye-opening strength → Forehead lift ‘alone has no effect’

2. Try lifting your forehead upward with your hands.

→ If your eyes look clear and refreshed

= Forehead lift is effective

3. You have a habit of raising your eyebrows every time you open your eyes.

→ = Frontalis muscle overcompensation → Effects may be minimal

4. You have relatively thick skin.

→ Power transmission is weak, so the effect may be reduced

You can check the explanation starting from 2 minutes and 19 seconds in the video below. ^^

"Did your forehead lift fail? It's because of 'this'" The reason why you alone didn't see the effects of a forehead lift

In the next episode, I plan to explain revision forehead lift surgery.

Some people ask whether revision surgery isn't possible for a forehead lift,

and there are also people who believe, 'A forehead lift can only be done once in a lifetime.'

However, that is not necessarily true, and I can tell you that it is an incorrect rumor(?).

Recently, many people have been visiting our clinic with concerns about revision forehead lifts,

and even if you have had revision surgery two, three, or more times, through proper analysis and consultation,

and if you undergo surgery after an accurate solution is devised,

you can achieve better forehead lift results than before.

If you are concerned, please visit our SH Plastic Surgery Clinic and, through a consultation,

let us thoroughly discuss whether revision surgery is possible for you.

We will continue the story about revision forehead lifts in the next episode. ^^

SH Plastic Surgery Clinic