Subcutaneous Forehead Lift: Technique and Early Results

Abstract

Objective: To present our indications, technique, and results for a modified subcutaneous forehead lift. Methods: Retrospective chart review of 16 patients who underwent a subcutaneous forehead lift. Results: Tumescent anesthesia was used in all 16 patients. Seven patients underwent the procedure without the use of a fibrin sealant, whereas a commercially available fibrin sealant was used in the other 9 surgeries. In 1 of 7 patients in whom a fibrin sealant was not used, a postoperative seroma was evacuated in the first 24 hours after surgery. In patients in whom a fibrin sealant was used, there were no cases of hematomas or seromas. Twelve patients had concomitant upper eyelid surgery (ptosis repair and/or blepharoplasty), and 4 patients had no upper eyelid surgery. Two patients had a small dehiscence with no long-term sequelae. There were no instances of keloid formation. Postoperative brow position was judged to be good in 9 patients, adequate in 4 patients, and undercorrected in 3 patients. Forehead rhytids were improved in all patients. There were 2 cases of asymmetry, 1 of them in a patient with a history of Bell's palsy. There were no cases of symptomatic postoperative scalp hypoesthesia or decreased forehead movement. Our analysis revealed a trend toward improved postoperative brow position with increasing experience, which was manifested in a more aggressive release of the subcutaneous attachments of the lateral brow and a larger skin excision. Conclusions: Subcutaneous forehead lift with tumescent anesthesia and a fibrin sealant is a safe and effective technique that provides the surgeon with good control of brow positioning while directly addressing forehead rhytids. It avoids significant postoperative scalp hypoesthesia. In our series, the use of a fibrin sealant was correlated with elimination of postoperative hematoma or seroma, even though these patients had no postoperative pressure dressings. This technique can be an important addition to the oculofacial surgical armamentarium.