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 other conditions that may be improved by surgery in this area, including frown muscle imbalance, transverse forehead rhytids, and lateral brow laxity. Recently, a better understanding of the relevant anatomy and the evolving therapeutic modalities (including both open and closed techniques) have contributed to a renewed interest in aesthetic surgery in the forehead and brow area. One hundred consecutive patients were studied, each of whom underwent forehead rejuvenation for one of four indications-forehead rhytids, glabellar creases, lateral brow laxity, or brow ptosis. Thirty-eight percent of patients underwent open procedures, 30 percent underwent closed procedures, and 32 percent underwent limited procedures. Complications occurred in 4 percent of patients, including three patients who were dissatisfied with the surgery and one patient who required scar revision. Based on our findings, we formulated an algorithm that integrates the different indications and any concomitant procedures being performed. Our proposed treatment plan is based on this information. The algorithm may be used as a template when assessing a patient and adapting the recommended intervention to the individual patient.