ENDOSCOPICALLY ASSISTED FOREHEAD-BROW RHYTIDOPLASTY - THEORY AND PRACTICE

Forehead-brow rhytidoplasty has evolved from a procedure primarily adv ocated for brow ptosis, to one in which a group of deformities are rou tinely addressed. It has also become evident that the surgical results stem from wide undermining with release of the periosteum and the con comitant alteration of the forehead muscles and not necessarily from s kin lifting using elevation/excision ratios. Therefore, with the intro duction of endoscopically assisted techniques to plastic surgery, the indications for a long forehead incision and its untoward sequelae hav e to be reconsidered. The anatomic basis for minimally invasive forehe ad-brow rhytidoplasty and three types of procedures are discussed. The se include Type I-complete, endoscopically assisted forehead-brow rhyt idoplasty; Type II-segmental, in conjunction with facelift surgery; an d Type III-isolated, frown-muscle modification. The role of fixation ( external support, internal suspension, or excision techniques) is desc ribed. Results suggest that these options provide a worthwhile alterna tive to traditional ''open'' techniques in certain circumstances, alth ough some relevant questions remain unresolved.