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Finesse in Forehead and Brow Rejuvenation: Modern Concepts, Including Endoscopic Methods

Drolet, Brian C. M.D.; Phillips, Benjamin Z. M.D., M.P.H.; Hoy, Erik A. M.D., M.B.A.; Chang, Johnny M.D.; Sullivan, Patrick K. M.D.

Plastic and Reconstructive Surgery: December 2014 - Volume 134 - Issue 6 - p 1141–1150
doi: 10.1097/PRS.0000000000000756
Cosmetic: Original Articles
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Discussion

Background: The brow and forehead are essential elements of the facial aesthetic architecture. Although frequently overlooked in youth, signs of facial aging are often most noticeable in the upper third of the face. Ptosis and loss of contour in the brows, along with temporal volume loss, sagging of periorbital tissue, and rhytides in the forehead, are common presenting complaints for aesthetic surgery. Although use of nonsurgical procedures (e.g., neuromodulators) has become very common practice, knowledge of surgical anatomy and interventions for brow and forehead rejuvenation are critical for a plastic surgeon. The earliest descriptions of brow-lift procedures are nearly a century old. Techniques have evolved significantly, to the point that patients may now return to work within 1 week of surgery, with minimal or no stigmata from an operation.

Methods: The literature and a series of cases from the senior surgeon (P.K.S.) were reviewed.

Results: A minimally invasive approach with an endoscope for dissection and repositioning of the brow was used in all patients. The authors have found that permanent suture fixation with cortical tunnels can produce an excellent, long-lasting aesthetic result for not only the forehead and brow but also the lateral periorbital and temporal regions.

Conclusions: Although each operation is tailored to the patient’s individual anatomy, the authors’ approach to the endoscopic procedure is described in this article, along with a review of anatomical and surgical considerations. Finally, several patients provide demonstrative results from the senior surgeon’s series of 546 patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Supplemental Digital Content is available in the text.

Providence, R.I.; St. Louis, Mo.; Newark, Del.; and Palo Alto, Calif.

From the Department of Plastic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University; the Division of Plastic and Reconstructive Surgery, Washington University; Premier Dermatology & Cosmetic Surgery; and the Department of Plastic Surgery, Palo Alto Medical Foundation.

Received for publication November 25, 2013; accepted March 25, 2014.

Presented at the 79th Annual Meeting of the American Society of Plastic Surgeons, in Toronto, Ontario, Canada, October 1 through 5, 2010.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (www.PRSJournal.com).

Patrick K. Sullivan, M.D., 235 Plain Street, Suite 502, Providence, R.I. 02905, cosmetic@drsullivan.com

©2014American Society of Plastic Surgeons