45.6.6Forehead Endoscopic Rejuvenation

This is done through endoscopy and small incisions in the scalp. The aim is to lift the eyebrows, stretch the forehead, and hold the galea up by fixing it to the parietal bone.

Later on, both these planes are joined in order to get the zone detachment. The technique principle is to slide two blades one over the other. Then according to the vectors drawn, the suspension points are fixed with Ethibond 3–0 in the temporal region (2–3) of the superficial fascia to the deep fascia and in the periosteum frontal–medial to the galea. The scalp is closed with mechanical suture (staples). Later on, it is splinted with one inch skin colored Micropore tape.

45.6.7Minimally Invasive Ciliary-Frontoplasty

This is done through small incisions in the scalp. When it is the sole procedure, it can be performed with sedation using local anesthesia containing 2% lidocaine with epinephrine. The incisions are those used in endoscopic surgery in the scalp temporal region 1.5–2 cm from the hairline (Fig. 45.4), with No. 15 blade, at a 45º angle in order to avoid injuries of the hairy follicles that will cause alopecia and scars in the zone. When there is need to lift the eyebrow body, the dissection is extended to the eyebrow body and to the hairline level using a 1.5 cm. incision, parallel to the imaginary line previously drawn. Once the incisions are made to the surgical plane that we look for in the temporal region between the superficial and deep temporal fascia, dissection is beneath the orbital edge and the orbicular myotomies in its superior-external part are carried out. The plane is subperiosteal in the frontal medial region.

45.7 Complications

With the technique of minimally invasive ciliary-fron- toplasty, there has been no type of complications since it was established. In the universal medical literature the following complications are detailed:

ss Loss of sensitivity

ss Pain, swelling, and hematoma

ss Temporal loss of the expressive movements ss Sensation of oppression in the forehead

ss High initial position of the eyebrows ss Muscular paralysis of the frontal nerve ss Necrosis

ss Infection

ss Hematoma and haemorrhage ss Scar

ss Eyebrows or eyelids asymmetry ss Chronic pain

ss Overcorrection

45.8 Conclusions

The minimally invasive ciliary-frontoplasty was used in 290 patients with ptosis of the eyebrow tail and

a

eyebrow ptosis during a 7-year period (2000–2007). The results were very good and improvement between 98% and 100% was noted with minimum or zero complications (Figs. 45.5–45.7).

b

References

1.Lexer E. Die gesamte Wiederherstellungs-Chirurgie, Vols. 1 and 2. Leipzig: Jahann Ambrosius Barth; 1931.

2.Noel A. La chirurgie esthetique et son role social. Paris: Masson; 1926. p. 62–6.

3.Joseph J. Nasenplastik und sonstige Gesichtplastik nebst einen Anhang uber Mammaplastik. Leipzig: Kabitzch; 1931. p. 507–9.

4.Hunt HL. Plastic surgery of the head, face, and neck. Philadelphia: Lea & Febiger; 1926.

5.Fomon S, Goldman IB, Neivert H, Schattner A. Face-lift operation by rotation flaps. Arch Otolaryngol. 1951;54(5): 478–92.

6.Uchida JI. A method of frontal rhytidectomy. Plast Reconstr Surg. 1965;35:218–22.

7.Marino H, Gandolfo E. Treatment of forehead wrinkles. Prensa Méd Argent. 1964;51:1368–71.

8.Vinas JC. Plan general de la ritidoplastia y zona tabu. In: Transactions of the 4th Brasilian congress on plastic surgery, Porto Alegre, 5–8 Oct 1965; p. 32.

9.Coiffman F. Elevación de cejas y frente por incisiones mínimas y sin endoscopio. Enfoque personal. In: Coiffman F, editor. Cirugía Plástica, Reconstructiva y Estética. Tomo II. Venezuela: Amolca; 2007. p. 1108–15.

10.Paul M. The evolution of the brow lift in aesthetic plastic surgery. Plast Reconstr Surg. 2001;108(5):1409–24.

11.Latarjet M et al. Anatomia humana, Buenos Aires. Médica Panamericana 2005:304–315.

12.Sastoque C et al. Estudio de tres diluciones de toxina botulínica tipo A. Rev Colombiana Cir Plast Reconstr. 2002; 8(2):1.

13.Guerrerosantos J. Autologous fat grafting for body contouring. Clin Plast Surg. 1996;23(4):619–31.