Forehead Rejuvenation

Chapter 40. Forehead Rejuvenation

Renato Saltz, MD, FACS; Omid Adibnazari, BS; Alyssa Lolofie, BS

INDICATIONS

Brow aesthetics cannot be generalized because of a changing of the ideal shape and position of the brow. Although the brow should be evaluated based on gender, ethnicity, orbital shape, and overall facial aging and proportions, the main factor to consider is the ratio of the visible eyelid to the palpebral fold. The best candidates for forehead rejuvenation are patients with eyebrow ptosis, asymmetry, temporal hooding and forehead wrinkles. Usually they also have short, flat foreheads and nonreceding hairlines (Fig. 40-1).

Figure 40-1 Brow aesthetics and ideal patients.

PREOPERATIVE PREPARATION

Assessment of the patient includes evaluation of both the medial and lateral brow position, the ratio from brow to upper eyelid, glabella and forehead lines, forehead shape and height, and the hairline. To assess the strength of the muscle action, movement, and depth of soft-tissue folds the patient should be asked to frown as well as to raise the eyebrows. The eyebrows should also be assessed for the thickness, shape, and position. In preoperative consultation the doctor should advise as to the number of incisions and type of fixations. Based upon the patient assessment, the operation can be planned. Patient inclusion is important in that brow lifts are individualized (Fig. 40-2).

Figure 40-2 Ideal patient picture.

The endoscopic technique is based upon the use of modern technology where the traditional eye-hand surgical coordination is done through a video-endoscopic system. Additional extensive training is necessary not only for the surgeon but all medical and nursing personnel involved in the surgical case. (Note from author: The novice should take his or her first assistant to cadaver workshops/courses to learn together.) The equipment, from endoscope to camera and monitors, are usually standard in centers where aesthetic surgeries are performed. It has become important to test each system, inspect each instrument and check for a backup system as a safeguard. The surgeon must have knowledge of the principles extending from training, mechanical equipment, and technical skills.

POSITION AND MARKINGS

In preparation for the procedure, the patient is marked from a standing position to utilize the natural positioning of the brows. Markings are made on both sides of the face outlining the temporal ridge, sentinel veins, and the

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