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A Reappraisal of Surgical Techniques and Efficacy in Forehead Rejuvenation

Guyuron, Bahman M.D.; Lee, Michelle M.D.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 426–435
doi: 10.1097/PRS.0000000000000483
Cosmetic: Original Articles

Summary: Forehead rejuvenation has an essential role in overall facial rejuvenation. Despite the evolution of rejuvenation techniques, principles of forehead rejuvenation remain the same. Circumspect facial analysis provides a crucial foundation in selecting the appropriate surgical technique and in optimizing the final aesthetic outcome. Today, myriad surgical options exist to address the senescent forehead. For example, the procedure can be performed through open, coronal, pretrichial, limited, or endoscopic incisions. The goal of this review article is to provide a simple and systemic approach to forehead rejuvenation. Common components of an aging forehead are reviewed. For each problem, a reappraisal of indications and efficacy of available surgical options is suggested. Of note, elevation of eyebrows on patients who have eyelid ptosis, proptosis, or deep tarsal crease should be avoided or carried out conservatively. It should often be performed in conjunction with ptosis correction and fat injection to the hollowed upper eyelid. On men with a receding hairline, the corrugator supercilii muscles are removed through the transpalpebral approach and the temple is lifted through two radial incisions and endoscopic dissection.

Cleveland, Ohio

From the Department of Plastic and Reconstructive Surgery, University Hospitals Case Medical Center, Case Western Reserve University.

Received for publication December 18, 2013; accepted January 30, 2014.

Disclosure: The authors have no conflicting financial interests or commercial associations to declare.

Bahman Guyuron, M.D., Department of Plastic Surgery, Case Western Reserve University, 29017 Cedar Road, Cleveland (Lyndhurst), Ohio 44124,

©2014American Society of Plastic Surgeons