19 Coronal Foreheadplasty Improves Periorbital Appearance and Rejuvenation Not Achieved by Facial and Eyelidplasties Alone
Summary
A foreheadplasty should be considered to correct deformities and signs of aging of the forehead and periorbital region, which cannot be adequately treated by facial and eyelidplasties alone.
19.1 Patient History Leading to the Specific Problem
This 64-year-old woman desired aesthetic facial surgical rejuvenation (Fig. 19-1). She was overweight and said that she had tried but could not lose any weight. She accepted her status and wished to proceed with surgery. Though she was advised to undergo forehead surgery as well as eyelid and facialplasties, she opted to only have the latter, which included bilateral lateral canthoplasties and a perioral dermabrasion.
19.2 Anatomic Description and the Patient’s Current Status
The patient was initially pleased with the results of surgery, but within a month she became unhappy due to the continued presence of drooping brows, transverse furrows of her forehead, vertical glabellar frown lines, and transverse creases across the radix of her nose and the glabellar region of her forehead (Fig. 19-2).
19.2.1 Analysis of the Problem
An open coronal foreheadplasty was recommended to correct the residual deformities, in spite of the fact that the patient had a high frontal hairline. Alternative procedures were discussed. Since the patient had already undergone upper eyelidplasties, work on the procerus and corrugator muscles through an upper eyelidplasty approach was not recommended. An endoscopic browlift would be an acceptable approach, but the surgeon preferred an open approach because of the long-lasting good results and minimal complications which had been consistently obtained with that procedure.
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