Since the introduction of the endoscopic brow lift in 1994, open brow lifts have seen a decline in popularity. However, the open coronal technique remains effective and is the gold standard against which all other forehead rejuvenation procedures are compared. In selected patients, it remains the best approach to achieving forehead rejuvenation.
The open approach affords the advantage of superior exposure, release of adhesions, muscle excision, brow mobilization, and excess scalp excision. Disadvantages include a significant scar, numbness, dysesthesia, and alopecia. Compared with the endoscopic brow lift, the open procedure is a better alternative for patients with a high receding hairline and a convex frontalis bone. These morphologic features present insurmountable problems to instrumentation during an endoscopic brow lift.
Endoscopic brow lifting has achieved wide physician and patient acceptance as a means for achieving rejuvenation of the upper face. The procedure is associated with durable results and can be effectively combined with other procedures. The advantages of endoscopic brow lifting include short camouflaged scars, resection of glabellar muscles under direct and magnified vision, preservation of scalp sensation by avoidance of nerve transection, and decreased alopecia.
When performing a brow lift, the surgeon should appreciate the following anatomic features:
The temporalis muscle.
Relationship of deep temporalis fascia and parietotemporal fascia.
The course of the frontal branch of the facial nerve.
The temporal crest.
The lateral and medial (sentinel) temporoparietal veins.
The course and branching of the supratrochlear and supraorbital nerves.
The origin and insertions of the corrugator, supercilii; and procerus muscles as well as their relationship to the supratrochlear and supraorbital nerves.
PATIENT EVALUATION & SELECTION
The ideal candidate for brow lifting has brow ptosis with caudad migration of the brow line, deep static forehead rhytides, dynamic glabellar rhytides, or asymmetry of brows. Patients usually describe these findings as “constantly appearing to be tired.” Descent of the brows may be the result of senescence, trauma, or hereditary factors. Asymmetry of the brows may exist as a congenital condition.
The aforementioned criteria are excellent indications for brow elevation; however, in addition, patients with a low thick hairline combined with a short flat, as opposed to tall convex, forehead are suited for endoscopic brow lifting. A tall convex shaped forehead may pose technical challenges as the convexity and length may not admit endoscopic instruments as easily as a flat short forehead. The open brow lift is a better approach for these patients.
As with most elective cosmetic procedures, the patient’s general health status should be carefully reviewed before the patient undergoes surgery. Clear contraindications are preexisting cardiac conditions, presence of bleeding diathesis, previous frontal craniotomy, and frontal sinus fracture.
Advanced age does not disqualify a patient from undergoing brow lifting, providing a review of their general health does ...