Doctor's Column

Revision forehead lift is a high-difficulty surgery that requires a thorough re-evaluation when the initial results are unsatisfactory due to insufficient temporal dissection, fixation failure, or inadequate ligament release, or when discomfort arises from overcorrection. It is essential to precisely understand the structural relationship between the eyebrows, forehead, and temporal ligaments to closely diagnose why revision surgery is needed and whether it is feasible. Depending on skin laxity, scarring, and adhesion, a tailored approach can be taken—ranging from a secondary forehead lift to elevate the eyebrows again, to restorative surgery to reverse overcorrection. Based on real-world clinical cases, this article provides a detailed explanation of the principles of revision forehead lift, covering cases where revision is necessary, cases where revision is difficult, the principles of overcorrection restoration, and combined procedures involving the hairline, sub-brow lift, and ptosis correction. It includes professional insights into anatomy, dissection extent, fixation points, and scar management, all of which are essential to know for a successful forehead lift.

Face Designer Dr. Sung-hoon Kim, SH Plastic Surgery

In my previous post,

I mentioned that "the biggest reasons for forehead lift failure are insufficient temporal dissection and fixation failure."

The forehead and eyebrows move as a single unit that includes the temporal region.

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

the eyebrows may only stay lifted temporarily and can drop again within 3 to 6 months.

At this point, there is a question that patients ask most frequently.

"Doctor, if a forehead lift goes wrong once, is that the end of it?"

Today, I would like to answer this question

under the topic of "Revision Forehead Lift and Restorative Surgery."

1. Is a revision forehead lift really possible?

To put it simply,

"A revision forehead lift is entirely possible."

Barring exceptional circumstances,

there is no absolute rule stating that a revision forehead lift cannot be performed.

However, there are far more factors to consider compared to the primary surgery,

and because tissue damage, scarring, and remaining skin laxity must all be taken into account,

it should be regarded as a surgery of higher difficulty.

Revision surgery is usually required in three scenarios.

① Inadequate results

When the change after surgery is minimal, or

when the eyebrows were slightly lifted initially but dropped again within a few months.

In these cases, as mentioned earlier,

the causes are often insufficient temporal dissection, inadequate ligament release, or fixation failure.

② Overcorrected cases – 'Surprised rabbit eyes'

When the eyebrows are excessively raised, making the forehead look permanently surprised, or

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

In this scenario, what is needed is not a revision surgery to lift them again,

but **'restorative surgery' to lower the eyebrows.**

③ Revision surgery due to aging

As 5 to 10 years pass after the initial surgery,

if the forehead and eyebrows gradually droop again,

you can consider one more correction naturally in accordance with the aging process.

Most patients can consider that

revision surgery is generally possible about 2 to 3 times in their lifetime.

Of course, achieving results that last as long as possible with just one surgery

is the most ideal outcome from both my perspective and the patient's.

2. Then, in what cases is revision surgery difficult?

Not all revision surgeries are possible.

The following cases require careful consideration.

① Cases where there is too little skin remaining

If the skin was already pulled too much in the initial surgery,

so the eyes cannot close properly,

or if it is expected that lifting further will definitely cause lagophthalmos (inability to close the eyes completely),

a "revision surgery to lift further" is impossible in this case.

Rather, this is a situation where you should consider restorative surgery to lower the eyebrows.

② Cases where severe scarring or adhesions cause a complete lack of mobility

If the forehead and eyebrow area are stiff and hardened from previous surgery,

and do not move well when examined by touch,

in cases like this,

even if the internal scar tissue is sufficiently dissected and removed,

mobility may still be restricted,

meaning the effects of the revision surgery might only be partial.

Before surgery, it is essential to

directly touch the eyebrows,

pull the forehead skin,

and observe the patient opening and closing their eyes and making facial expressions,

in order to comprehensively evaluate skin redundancy, elasticity, and scar location.

3. Forehead lift: How many times can it be done in a lifetime?

I also get asked this question often.

"Doctor, I heard a forehead lift can only be done once in a lifetime?"

Here is the answer.

Theoretically, revision surgery is possible multiple times.

However, considering the skin laxity, scar condition, and extent of tissue damage,

realistically, it is safe to consider 2 to 3 times as a reasonable upper limit.

That is why I always tell people this:

"What is more important than the number of surgeries itself

is whether the first surgery was right for your face."

If the initial indication was incorrect from the start,

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

4. Surgeries worth considering alongside a forehead lift

Just because it is a forehead lift revision surgery

does not mean we only look at the forehead.

We must consider the impression of the entire upper face together.

① Forehead reduction surgery (hairline lowering)

For those with a very wide forehead,

having a forehead lift can actually create an optical illusion where the forehead looks even wider.

In this case, performing a forehead reduction by advancing the hairline forward together

can yield a more harmonious result.

② Double eyelid surgery (incisional upper blepharoplasty)

Although the brow position improves with a forehead lift,

it does not correct all double eyelid asymmetries or line shapes.

If you want a symmetrical appearance,

double eyelid surgery is sometimes considered concurrently.

③ Upper eyelid fat grafting

When the eyebrows are elevated through a forehead lift,

there are cases where upper eyelid hollowness (sunken upper eyelids) becomes more pronounced.

In such cases, supplementing volume through upper eyelid fat grafting

can create a much softer appearance.

5. Points to Be Particularly Careful About in Revision Forehead Lift

① Selection of Incision Site

At the existing incision site,

hair loss,

thick scarring,

or adhesions

if severe, rather than using the same spot,

scar revision is combined or a new incision location is selected.

② Scars Holding Like a 'Retaining Ligament'

After the first surgery, instead of the anatomical ligament,

there are cases where scar tissue holds the eyebrow.

In this case, not the ligament at the original position,

but the "scar acting as a pseudo-ligament" must be released

for the eyebrow to move naturally again.

③ Risk of Overcorrection

Just because the effect was insufficient,

there are cases where patients request, "Please lift it higher this time."

However, without considering skin elasticity, laxity, and the degree of eye closure,

if lifted excessively,

a surprised expression

or difficulty closing the eyes

such problems may occur.

Especially in revision surgery, the 'limit of how much it can be lifted'

is crucial to calculate accurately.

6. Revision Surgery to Lift the Eyebrows vs. Reconstructive Surgery to Lower the Eyebrows

Revision forehead lift can be broadly divided into two types.

① Re-forehead Lift That Lifts Again

When the effect was insufficient, or

when it has dropped down again over time

→ Expanding the dissection range to the temples and

After sufficiently releasing the ligaments,

it is securely fixed to the deep temporal fascia

to elevate the eyebrows again.

This surgery belongs to a relatively low level of difficulty.

② 'Restorative Forehead Surgery' to Reverse Overcorrection

When the eyebrows are excessively raised, making one look constantly surprised,

or when there is lagophthalmos where the eyes do not close completely,

a surgery to lower the eyebrows back down is required.

If it is after a forehead reduction surgery where tissue has already been excised,

the difficulty level becomes even higher.

A wider range of dissection,

resolution of scars and adhesions,

and repositioning of remaining skin and tissue—

because all these processes must be performed simultaneously,

you can consider it "a surgery of a much higher difficulty than a revision lift."

In actual cases as well,

looking at pre-operative photos shows a constantly surprised expression

and lagophthalmos where the eyes do not completely shut when closed,

but after restorative surgery, the eyebrow position naturally lowers

and the eyes can be closed comfortably.

Reflections by Facial Designer Dr. Kim Seong-hoon

Revision forehead lift surgery

is not merely a question of "Should we raise or lower it a bit more?"

How much skin remains,

how much the forehead and eyebrows move,

what kind of internal scars are holding things down,

and where the temporal ligaments and fixation points are located—

it is a surgery that simultaneously considers anatomy, function, and aesthetics.

It is best not to undergo revision surgery.

To ensure that, from the very beginning,

consult thoroughly with a board-certified plastic surgeon,

"Do I really need a forehead lift?"

"If I do need it, to what extent is appropriate?"

You must first find the answers to these questions.

If you have already had a forehead lift,

but see no effect or experience discomfort due to overcorrection,

please do not worry alone;

I recommend having the actual condition of your eyebrows, forehead, and eye closure examined in person.

At SH Plastic Surgery,

so that each patient's forehead and eyebrows

can find the most natural and comfortable position,

I will think through the process with you until the very end.

A forehead lift with no failure in revision surgery,

begins with an accurate diagnosis and thorough consultation.

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

SH Plastic Surgery Clinic