Answer:
The primary indications for forehead/brow lifts are forehead/brow ptosis and lateral upper lid ptosis. However, a forehead/brow lift also helps correct transverse forehead lines and creases, glabellar creases, and transverse folds at the root of the nose.
In some patients, correction of transverse forehead lines and/or glabellar creases, rather than brow ptosis, is the main indication for the procedure. In such patients, attention is directed toward interrupting the muscle activity rather than toward elevation of the forehead. Like any aesthetic procedure, it is tailored to suit the individual.
The endoscopic approach to forehead/brow lifting has become popular in recent years. Questions remain regarding the extent to which the brow can be elevated endoscopically without scalp excision, and regarding the longevity of the elevation. The coronal lift remains the standard.
Before induction of anesthesia or administration of intravenous sedation, with the patient in the sitting position, vertical glabellar lines and transverse forehead lines are marked. Fine scissors are used to spread the corrugator muscles to locate the branches of the supratrochlear nerves. After the nerves have been identified, the corrugator muscles can be resected, taking care to leave some corrugator muscle on the forehead flap to prevent a depression in this area.
Attention is then directed to the glabellar creases. Needles are passed through the flap from outside to inside at the upper and lower limits of the previously marked glabellar creases to locate them precisely on the inside of the flap. A scalpel is used to incise the muscle on all four sides of each glabellar crease, forming an island of soft tissue under each crease that has been isolated from the surrounding muscle.
Modification of the frontalis muscle is controversial. Since the frontalis muscles elevate the forehead (the goal of the procedure), one is hesitant to weaken the function. To some extent, elevating the brow to a higher level, thereby eliminating upper eyelid overhang, allows the patient to relax the frontalis muscles and decreases the prominence of the transverse lines. For this reason and because brow lifting is more frequently performed via an endoscopic approach, aggressive resection of the frontalis muscles has been abandoned.
Other techniques include:
Collagen injection
Botox injection
Dermabrasion
Laser resurfacing
Chemical peeling
Fat/dermis implantation
Fat injection
Direct resection