The difficult forehead

Abstract

Stanley Klatsky, MD Bruce F. Connell, MD Robert W. Bernard, MD Rollin K. Daniel, MD Dr. Klatsky: The first patient is a 58-year-old woman who is unhappy with her forehead and upper lid appearance (Figure 1). People tell her she looks angry. Note that she is blind in her right eye. Dr. Bernard, how would you improve her forehead, brow, and upper lid complex? Figure 1 This 58-year-old woman is unhappy with her forehead and upper eyelids. People tell her that she looks angry. Dr. Bernard: She does look angry and sad, but it is not just because of her upper face. Her blindness in one eye is an important consideration. I might hesitate to remove fat from her upper eyelids just to avoid the possibility of retrobulbar hematoma. She has a reasonably high forehead, and her brows appear relatively low. I would seriously consider an endoscopic brow lift despite her somewhat high forehead and a skin, only upper lid blepharoplasty. I would resect the procerus and corrugator muscles medially, and I would consider Botox to further improve the transverse forehead lines. Dr. Klatsky: Dr. Connell, how would you approach treatment? Dr. Connell: I always like to see an early photograph from a time when the patient was pleased with his or her appearance; from this I note the desired brow position. Brow placement is easier to determine in women because I simply strive to make them look as pretty as possible, but for men there are about 5 different acceptable brow locations. From this photograph, the height from her nasion to her hairline is 16 cm, and the height from her nose to her chin is 12 mm. She is about 30% higher on the upper third of her face than the lower third. I would avoid making her forehead look …