COMPARISON OF SUBPERIOSTEAL VS SUBGALEAL ELEVATION TECHNIQUES USED INFOREHEAD LIFTS

Objectives: To compare eyebrow and forehead elevation and tension amon g the following 3 surgical techniques: subperiosteal dissection to the supraorbital rim, subperiosteal dissection with release (elevation, i ncision, and spread) of periosteum at the supraorbital rim, and subgal eal dissection to the supraorbital rim, and to determine the optimal m ethod of elevation in an aesthetically accepted range for the endoscop ic forehead lift. Design: A randomized, self-controlled study using an open approach to the forehead in cadaver heads. Each half of head was compared with the other in the following 2 study groups. subperiostea l dissection without release vs subperiosteal dissection with release of periosteum (group 1) and subperiosteal dissection with release of p eriosteum vs subgaleal dissection. Setting: Anatomy laboratory at a un iversity medical center. Subjects: Eight cadaver heads fixed with ethy lene glycol in each group. Intervention: Predissection distances in mi llimeters from fixed anatomic landmarks were measured. The forehead fl aps were elevated using a coronal incision and divided with a midline incision for side-to-side comparison. Cadaver heads and side of surgic al intervention were selected randomly. The flap tensions associated w ith incremental flap advancement of 0.5 and 1.0 cm were measured. Trac tion of 2.2 kg was then applied to each flap, and distances between th e fixed landmarks were measured. Main Outcome Measures: Mean predissec tion and postdissection distance of brow and forehead elevation for ea ch dissection type and mean distance and median tension of brow and fo rehead elevation within each group. Results: The mean postdissection b row measurements at rest were significantly greater than the mean pred issection measurements at most landmarks in all dissections for both g roups (P<.05). The mean postdissection brow and forehead measurements with 2.2 kg of traction were significantly greater than the mean predi ssection measurements at all landmarks in all dissections for both gro ups (P<.05). The mean increase in distance from predissection to postd issection (at rest and with 2,2 kg of traction) did not significantly differ between the different dissection types (P>.05). For group 1, th e median flap tension for subperiosteal dissection without release was greater than that for subperiosteal dissection with release (P>.05). Far group 2, subperiosteal dissection with release had greater median flap tension than subgaleal dissection (P>.05). Conclusions: All 3 met hods of dissection significantly elevated the brow at rest for most la ndmarks. All 3 methods of dissection significantly elevated the brow a nd forehead when traction was applied to the flap. Brow and forehead e levation at rest and with 2.2 kg of traction did not significantly dif fer between the dissections. Subgaleal dissection was associated with less flap tension compared with the subperiosteal dissection with or w ithout release. The data support the use of all 3 methods of forehead dissection for brow elevation and subgaleal forehead dissection as the optimal approach for the forehead lift, whether performed endoscopica lly or open.