The Forehead Lift: Endoscopic Versus Coronal Approaches

Abstract

Rejuvenation surgery of the upper one-third of the face can be accomplished by a number of well-known techniques and approaches. The objectives of this study were to: (1) determine if endoscopic-assisted forehead lifts achieve the same degree of correction as the coronal/pretrichial forehead lifts, (2) to assess the effect of concurrent blepharoplasty on brow elevation, and (3) to evaluate long-term results of coronal/ pretrichial forehead lifts. The study was a retrospective blinded comparison of pre- and postoperative photographs of patients who underwent forehead lifts. In order to control for the differences in photographs, ratios of distances were measured utilizing standard anthropometric sites of the brow, medial canthus, and subnasale. All reviewed cases were operated on by the same surgeon (S.W. Perkins, M.D.). A total of 140 patients having undergone forehead lift procedures and with 12-month postoperative photographic documentation were included in the study. Of these 121 patients had coronal forehead lifts and 19 had endoscopic-assisted forehead lifts. Results revealed that at 1 year follow-up both methods achieved brow elevation without a significant difference in the approach. Concomitant blepharoplasty had no statistical effect on brow position. Additionally, long-term follow-up on the coronal/pretrichial lifts revealed a gradual drop in brow position over 5 years. We conclude that both endoscopic and coronal/pretrichial forehead lifts provide for comparable elevation at 1-year follow-up. Concomitant blepharoplasty has minimal to no significant effect on brow position. Brow elevation in coronal/pretrichial forehead lifts may be temporary.

Redução da região frontal com incisão pré-capilar: relato de experiência e indicações

“…Therefore, the endoscopic procedure or bicoronal incision provides better cosmetic results in patients with standard normal hair and a low anterior hairline. In contrast, precapillary incision is the best indication in patients with a high anterior hairline insertion (long forehead), extensive wrinkling, or very thin skin 6,[9][10][11][12][13][14][15][16][17][18] . In our experience, we have performed extensive subgaleal detachment, advancing the flaps from the forehead and scalp, without detecting cases of alopecia or flap necrosis.…”

“…However, recent advances in fixation techniques have led to longer lasting results and better acceptance of the procedure. Therefore, the endoscopic procedure is currently seen by many surgeons as the best option for forehead reduction, eyebrow ptosis correction, and periorbital and frontal muscle treatment, as it allows good visualization and minimal morbidity [10][11][12] .…”

“…Between 1980 and 1990, innovations in endoscopic approaches revolutionized orthopedics, general surgery, and gynecology, and reached plastic surgery, particularly procedures concerning forehead treatment 9,10 . However, coronal incisions or endoscopic procedures elevate the anterior hairline, which is one of the reasons why many surgeons do not routinely recommend these procedures 11,12 . These approaches are not suitable for patients with thin and sparse frontal hair, congenital/senile long foreheads, or extensive forehead wrinkles 6,[9][10][11][12][13][14][15][16][17][18] .…”

Coronal/Hemicoronal Approach – A Gateway to Craniomaxillofacial Region

“…Various indications for the coronal approach include severe craniomaxillofacial trauma, craniofacial deformities, craniotomy procedures, osteotomies of upper and middle one third of face, harvesting of bone and fascial grafts when indicated [5,6], for improved access to condylar regions [7], and also for forehead rejuvenation [8]. This study aims to prove that with minimal complications coronal/hemicoronal approach can be extensively used in the field of maxillofacial surgery.…”

Frontoplastia endoscópica: três anos de experiência

“…A number of techniques may be used in order to elevate the eyebrows. Endoscopic frontoplasty represents a significant development, having replaced the classic coronal and pre-trichia technique [1][2][3][4] . It allows for a forehead and eyebrows cosmetic enhancement without causing disproportional changes to facial anatomical relations.…”