Evaluating rejuvenation of the forehead and brow: An algorithm for selecting the appropriate technique

The traditional reason for performing aesthetic surgery in the forehead and brow area has been to correct brow ptosis. However, there are several othe r conditions that may be improved by surgery in this area, including frown muscle imbalance, transverse forehead rhytids, and lateral brow laxity. Rec ently, a better understanding of the relevant anatomy and the evolving ther apeutic modalities (including both open and closed techniques) have contrib uted to a renewed interest in aesthetic surgery in the forehead and brow ar ea. One hundred consecutive patients were studied, each of whom underwent foreh ead rejuvenation for one of four indications-forehead rhytids, glabellar cr eases, lateral brow laxity, or bro iv ptosis. Thirty-eight percent of patie nts underwent open procedures, 30 percent underwent closed procedures, and 32 percent underwent limited procedures. Complications occurred in 4 percen t of patients, including three patients who were dissatisfied with the surg ery and one patient who required scar revision. Based on our findings, we formulated an algorithm that integrates the diffe rent indications and any concomitant procedures being performed. Our propos ed treatment plan is based on this information. The algorithm may be used a s a template when assessing a patient and adapting the recommended interven tion to the individual patient.