Endoscopic Forehead Lift Using Pretrichial Vertical Incisions and Solid Suture Technique: Effective Fixation and Lesser Scar Formation.

Abstract

Endoscopic forehead lift with frontal incisions behind anterior hairline has been used conventionally not to exposure scar on the forehead. Accordingly, patients with convex forehead, high hairline, and redundant forehead skin are regarded as not good candidates for endoscopic forehead lift. However, we introduce the advantages of pretrichial vertical incision on the forehead using techniques that minimize the risk of scar formation. Between December 2019 and April 2021, 73 patients who underwent endoscopic forehead lift using pretrichial vertical incision and cortical bone tunnel fixation method were enrolled in this study. One plastic surgeon independently assessed postoperative 6 months scar using Scar Cosmesis Assessment and Rating scale, which include clinician questions and patient questions. Seventy-three patients (67 women and 6 men) with a mean age of 54.5 years (range, 19- 76 years) were included in this study. Skin sutures were stitched out 7.15 days after surgery (range, 7-8 days). All patients were followed up over 6 months. ''Overall impression" and ''patient question'' scored zero in all patients. In 14 patients, pencil-thin line was shown, and the other 1 patient showed a little hyperpigmentation in 1 scar out of 3 frontal scars. Erythema, track marks or suture marks, and hypertrophy/atrophy were scored zero in all patients. The worst total score was 1 in 15 patients. Pretrichial vertical incision with cortical bone tunnel fixation using nonabsorbable suture provides several advantages comparing to conventional incision behind anterior hairline. Scar, which is the only potential concern, was not substantive problem and can be overcome with our techniques.