Hairline incision with forehead vertical reduction seems best
The hairline incison is the best approach for patients wanting no eleveation or a reduction in the verticl height of their forehead. When closed with meticulous detail the incision can be very inconspicuous.
An anterior hairline incision is useful to treat a high forehead
If you already have a high forehead, > 7 - 8 cm in height then a hairline forehead lift is a definite consideration. Using this technique and incision is made just at the hair line. The trick is to bevel the incision in the direction of the hair follicles. This helps to preserve the hair and have hair grow through the scar. This helps to hide the scar. This is an excellent technique to use in a patient with a high forehead. There are downsides to this incision which include the length of the scar and numbness in areas of the scalp behind the scar.
If your forehead is already high and you want to reduce it you will need to do the incision at the hair line and the hair bearing scalp can be brought forward. This can be done with an endoscopic technique which preserves the sensory nerves or the coronal technique.
This is a nice technique to reduce the height of the forehead but you have to tolerate the scar line at the hair line.
Discuss this option with your surgeon and with good technique the scar should barely be noticeable.
Typically a brow lift performed behind the hairline will increase the height of the forehead. In order to reduce the forehead, you will have to have the browlift performed at the hairline and this may work well in you if you have a nice hairline and are not a male will the risk of male pattern baldness. Males with coarse forehead furrows might be able to have the browlift done with the incision in these furrows.
If you have a high forehead to begin with, an open brow lift with a hair line incision might be helpfull. It is a very powerful brow lift and in the same time it will decrease the width of the forehead. Regarding the sutures, a half buried mattress might give a better cosmetic appearance, but at the end, it is a technical detail and your plastic surgeon will be able to use his own preferred sutures.
Hairline incision to control forehead size in Brow Lift
Talk to your doctor about a Hairline Incision. The incision made during a Brow Lift can be at the hairline instead of behind it, which allows the surgeon to control the size of the forehead. This is done in the case of patients who have high foreheads or are concerned about having high foreheads as a result of brow lifts.
Actually making a beveled incision a fraction of an inch (few millimeters) behind the hairline retaining the follicles will often result in hair growing through the scar. If done by a skilled surgeon, the scar will often be nearly invisible. Consult with more than one plastic surgeon and ask to see before/after images of patients with hairline incisions.
Specialized browlift for forehead reduction
What sounds like would be the indicated procedure for your goals is the forehead reduction/hairline advancement procedure. This is a type of specialized browlift, in which the hairline is brought forwards, the brows elevated to the aesthetically appropriate amount, and overall the forehead is made smaller in size. This heals as a fine line scar along the hairline through which hairs grow.
Pretrichial Brow Lifts For Large Foreheads
If you have a long forehead, you may be a candidate for a pretrichial brow lift. In this procedure, an incision is made along the hairline to pull the brow up. In terms of the sutures used, my experience has been that eyelid incision tend to heal very well regardless of the type of suture used and if you look really closely you will have some type of scar on your eyelids. For the hairline incisions, a meticulous layered closure should produce an excellent and imperceptible result.
In order to lift the forehead but not the hairline, you want a pretricial browlift. An incision is made at the hairline, excess skin is removed and the desired result is achieved. The only warning is that the scar can be noticeable if made straight. I prefer to make a wiggly incision that moves in and out of the hairline into the scalp. This may sound off, but gives a great result.
Size of forehead after brow lift
Brow lifts are a very effective procedure to reposition and rejuvenate the brow. Depending on the technique used, the patient's hairline may be altered. This may create the appearance of a longer forehead. If this is a concern, consult with a board-certified plastic surgeon with a great deal of experience in the many different brow lifting techniques. There are good techniques that can hide the incision and minimize the elevation of your brow. Placing the incision at the front of your hairline can help reduce the appearance of a long forehead.