Endoscopic forehead surgery in a subgaleal plane allows selective manipulation of the forehead and glabellar muscles in accordance with their influence in forehead and brow deformity. Myotomy begins by interrupting the blend of the fibers of the elevator and depressor muscles, thereby exposing the bone fixation and cutaneous insertions of the depressor muscles. Myotomy of the depressor group is performed by section of the muscle fibers as close as possible to their bone fixation, with release of the cutaneous insertions at the brow level. The involuntary frontalis contraction free from the active opposition of the depressor muscles and free from the restriction of the inelastic structure of the periosteum stabilizes the brow elevation and gives a natural, long-term result. No fixation methods are used to hold the forehead flap in position. Transverse section of the frontalis muscle is performed to restore brow symmetry or excessive lift of the brow.
São Paulo, Brazil
From the Division of Plastic Surgery, General Hospital of Beneficência Portuguesa.
Received for publication April 19, 2002;
revised November 21, 2002.
Antonio Carlos Abramo, M.D.
Rua Afonso de Freitas 641
04006-052 São Paulo, Brazil