Rejuvenation of the Aging Brow and Forehead

CHAPTER 29 Rejuvenation of the Aging Brow and Forehead

Proportions of the Aesthetic Brow and Forehead

The forehead, from the eyebrows to the hairline, makes up the upper third of the face. The aesthetically favored forehead produces a gentle convexity on profile. Other shapes include sloping, flat, and protruding. The eyebrows generally follow a smooth, gently curving arc that extends from the lateral eyebrow around the nasion and down the lateral nasal sidewall (Fig. 29-1A). In women, the eyebrow should lie slightly above the supraorbital rim and follow a gently curving arc (Fig. 29-2). The eyebrow begins at a line drawn from the alar-facial groove through the medial canthus and ends at a line drawn from the alar-facial groove through the lateral canthus.1 In women, the highest point of the eyebrow arc is at a line drawn tangential to the lateral limbus. The medial and lateral ends of the eyebrow should lie in a horizontal line. The medial end should have a clublike configuration that gradually tapers laterally. In men, the brow usually lies at the level of the supraorbital rim (see Fig. 29-1B).

The Aging Brow and Forehead

Although different regions of the face age at variable rates and are influenced primarily by genetic factors, the upper third of the face ages in its own unique fashion (Fig. 29-3).2 As skin elasticity declines, the forehead, temple, and glabellar skin descend. The brow, especially in its temporal aspect, descends to or below the supraorbital rim with the effects of gravity causing temporal hooding. If brow ptosis is severe, a visual deficit may develop in the superior and temporal quadrant. The supratarsal crease disappears by overhanging ptotic upper eyelid skin. Crow’s feet (rhytids at the lateral canthus) appear secondary to gravity and repeated contraction of the orbicularis oculi muscle. Deep forehead creases appear due to the repetitive actions of the primary brow elevator, the frontalis muscle, in an effort to elevate the heavy, ptotic brow. Vertical, oblique, and horizontal rhytids appear in the glabella and nasion from contractions of the brow depressors—the corrugator, procerus, and depressor supercilii muscles.

Patient Selection

Anatomic Considerations

Analysis of the upper third of the face, from the eyebrows to the hairline, should begin with the assessment of interpersonal factors that may significantly affect the patient’s interpretation of successful surgical intervention and, as such, must be carefully examined. Age, gender, race, body habitus, and personality are the main interpersonal components that must be considered when assessing the eyebrow complex.4

When determining which brow-lifting procedure should be used, specific anatomic criteria should be evaluated when examining the patient. The patient should be examined in a sitting position and in facial repose. Manually elevating the brow reveals the favorable effect of brow elevation. Individuals with ptotic eyebrows often involuntarily attempt to elevate the brow with frontalis muscle contraction. To eliminate “pseudoelevation” of the brow, patients close their eyes and then slowly open them after allowing the frontalis muscle to relax. The true position of the eyebrow can then be evaluated in repose by the surgeon. Additionally, the eyebrow position can be examined with the patient’s eyes closed. The following are anatomic and physiologic factors to evaluate when considering a patient for aging forehead rejuvenative surgery:

Surgical Techniques

Traditional methods of forehead and brow rejuvenation, such as coronal, pretrichal, and direct brow lifts have provided facial plastic surgeons with effective brow elevation for many years. In the past decade, the endoscopic forehead and brow lift has rapidly become accepted as part of the surgical armamentarium and is frequently the technique of choice.68 The indications and contraindications for each forehead and brow-lifting procedure are described in Table 29-1.5

Table 29-1 Indications and Contraindications for Individual Forehead and Brow-Lifting Procedures

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Jun 5, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Rejuvenation of the Aging Brow and Forehead

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Procedure Indications and Advantages Contraindications and Disadvantages
Coronal forehead lift Treats all aspects of aging forehead and brow

Pretrichal forehead lift

Midforehead lift

Midforehead brow lift

Direct brow lift

Temporal lift