Endoscopic Forehead Rejuvenation: Using Bone Channels for Soft-Tissue Suspension

Abstract

Introduction: The use of endoscopic procedures to facilitate the rejuvenation of the upper face offers today's cosmetic surgery patient a less invasive and less morbid procedure, with comparable results to the various open techniques. Multiple methods of soft-tissue suspension have been utilized with varying results while performing endoscopic browlift procedures. All methods of suspension attempt to maintain the elevated brow, however they differ in length of time for fixation, use of hardware, and the need for secondary procedures. Purpose: The purpose of this article is to review various techniques of soft-tissue suspension for endoscopic forehead rejuvenation and describe the bone channel technique. Methods: The authors present a brief review of the history of soft-tissue suspension in endoscopic forehead rejuvenation ranging from the use of scalp excision to resorbable suspension screws. A procedure for the use of bone channels to maintain suture suspension of the soft-tissue flap, which is currently in use at their institutions, is presented. Results: The bone channel procedure is a simple, predictable technique that provides long term suspension of the soft-tissue flap, eliminates the use of hardware, and allows for immediate closure of the instrumentation ports. Conclusions: This simple technique of suture suspension using bone channels in the outer cortex of the cranial bone provides an inexpensive and predictable alternative for endoscopic forehead rejuvenation. Proper use can successfully effect a pleasing and natural look for the facial cosmetic surgery patient.