A Reappraisal of Surgical Techniques and Efficacy in Forehead Rejuvenation

SUMMARY: Forehead rejuvenation has an essential role in overall facial rejuvenation. Despite the evolution of rejuvenation techniques, principles of forehead rejuvenation remain the same. Circumspect facial analysis provides a crucial foundation in selecting the appropriate surgical technique and in optimizing the final aesthetic outcome. Today, myriad surgical options exist to address the senescent forehead. For example, the procedure can be performed through open, coronal, pretrichial, limited, or endoscopic incisions. The goal of this review article is to provide a simple and systemic approach to forehead rejuvenation. Common components of an aging forehead are reviewed. For each problem, a reappraisal of indications and efficacy of available surgical options is suggested. Of note, elevation of eyebrows on patients who have eyelid ptosis, proptosis, or deep tarsal crease should be avoided or carried out conservatively. It should often be performed in conjunction with ptosis correction and fat injection to the hollowed upper eyelid. On men with a receding hairline, the corrugator supercilii muscles are removed through the transpalpebral approach and the temple is lifted through two radial incisions and endoscopic dissection.