7 - Forehead rejuvenation

Abstract

To understand age-related changes in the forehead region as well as their surgical correction, a detailed knowledge of anatomy is required. Eyebrow position is the net result of forces that depress the brow, forces that raise the brow, and the structures that tether the eyebrow in place. Brow depression is caused by glabellar frown muscles, the orbicularis, and gravity. Frontalis is the only brow elevator. Attractiveness of the periorbital region is intimately related to eyebrow shape and eyebrow position as it relates to the upper eyelid and the upper lid sulcus. Aging causes enlargement of the orbital aperture as well as changes in eyebrow shape and position. Key elements of forehead rejuvenation are the attenuation of frown muscle action and the repositioning of ptotic eyebrow elements. The lateral eyebrow is often the only portion requiring elevation. Forehead rejuvenation can be accomplished using a combination of surgical and non-surgical techniques. Multiple surgical techniques for eyebrow shaping and repositioning are available: open coronal brow lift, open hairline brow lift, endoscopic brow lift, temple brow lift, transpalpebral brow lifting, browpexy, and direct suprabrow lifting. The aesthetic outcome of brow elevation surgery, when overdone, can be difficult to correct. More often, however, the problems with brow lift surgery relate to ineffectiveness or unattractive changes in eyebrow shape.