ENDOSCOPICALLY ASSISTED BIPLANAR FOREHEAD LIFT

The standard subgaleal coronal incision used for brow lifting is limit ed to patients with low foreheads. The subcutaneous hairline brow lift used for patients with high foreheads has a high rate of vascular com plications. However, the main advantage of the subcutaneous approach i s preservation of sensation posterior to the incision line. The subper iosteal approach, on the other hand, allows a better periorbital remod eling. I have combined the subperiosteal and the subcutaneous approach to take advantage of and minimize the disadvantages of each individua l approach. The advent of the endoscopic technique has allowed more ac curate and controlled periorbital dissection and brow depressor muscle modification. The operation is indicated in every patient in whom the anterior hairline incision is indicated. It is a good method for decr easing the height of the forehead. The dissection is done initially in the subcutaneous plane, and about halfway on the forehead slit incisi ons through the galea-periosteal layer and through the temporoparietal fascia are made to continue the dissection in the deep plane. The per iosteal dissection and release at the arcus marginalis is done under e ndoscopic control. Likewise, the brow depressor muscle modification is done under endoscopic magnification. Deep anchoring sutures fix the b row in the elevated position. Trimming and closure of the cutaneous la yer are done with minimal tension. The biplanar subperiosteal-subcutan eous forehead lift has been used in 24 patients with very satisfactory results. Complications have been of a minor nature. Patients have mai ntained sensation posterior to the hairline incision. The height of th e forehead has been decreased in every case. Frontalis muscle function has been preserved.