Brow Lifting and Forehead Rejuvenation: Proven, Effective, and Reliable Treatment.
Erik A. Hoy, MD, Johnny Chang, MD, Benjamin Z. Phillips, MD, Patrick K. Sullivan, MD.
Brown University - Rhode Island Hospital, Providence, RI, USA.
Minimally-invasive techniques can correct laxity, asymmetry, and ptosis of the soft-tissues of the brow and temporal region that produce the stigmata of aging. However, no large studies have evaluated their long-term outcomes. The senior author previously described the ligamentous attachments of the brow and how to aesthetically shape and independently control the position of the medial and lateral eyebrow.1 The goal of precise long-lasting repositioning of the medial, middle, and lateral thirds of the brow and temporal region spurred further studies into the most effective and safe treatments. This is an outcomes review of long-term aesthetic results and any associated complications.
Since our publication in 2006, we have a better perspective of what is effective, safe, and how to treat and avoid complications. This retrospective review was conducted to add an additional ten year segment between January 2000 and December 2009 to our study. A total of 546 patients underwent endoscopic brow rejuvenation during that period. Of these, 26 had hairline incisions for brow rejuvenation and 7 patients had scalp advancement. Medical records were reviewed for technique used and any complications. Pre- and postoperative photos were critically analyzed.
Of 546 patients reviewed, there was a high rate of concordance between patient and surgeon satisfaction with results. Five patients identified insufficient brow elevation with three undergoing revision. No patients had failure of their suture suspension requiring surgical intervention. One cortical drill hole produced intra-operative CSF leak in one patient which was easily and safely treated at the time without sequelae. This will be discussed.
Eleven patients experienced temporary alopecia and 1 had excision of two areas of alopecia around the incision sites one year postoperatively. There were no hematomas, infections, or hypertrophic scars.
Minimally-invasive techniques can reduce incidence of sequela including scalp scarring, paresthesias or alopecia and be very effective in terms of brow elevation verses the coronal approach, the technique still used by most plastic surgeons. We present the senior author’s preferred approach to endoscopic brow rejuvenation, long-term results, complications and treatment, and the situations in which a short scar is employed vs the hairline or coronal incisions. We demonstrate how to avoid over-elevation brow by preserving the medial brow ligamentous attachments. Because of the effectiveness and applicability of this endoscopic lift, coronal incisions have not been used in 10 years.
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