[Optimal forehead rejuvenation. Combining endoscopy-peel-botulinum toxin]

Area of Science:

• Plastic Surgery
• Cosmetic Dermatology
• Facial Rejuvenation Techniques

Background:

• Traditional resurfacing (trichloracetic or phenol peels) combined with newer technologies like endoscopic forehead plasty and botulinum toxin may improve forehead rejuvenation.
• Earlier foreheadplasty results were suboptimal, potentially due to weak percutaneous suture suspension.
• Transosseous suspensions, systematically used since 1998, have improved forehead lift outcomes.

Observation:

• The popularity of botulinum toxin has led to a decrease in endoscopic forehead surgery.
• Endoscopic procedures are now primarily used for significant frontal ptosis (lifting up to 1.5 cm) to prevent unnatural results.
• A transpalpebral approach can offer benefits without endoscopy.
• Upper blepharoplasties are frequently performed to achieve natural-looking results.

Findings:

• Transosseous suspensions have overcome limitations of previous suspension methods in foreheadplasty.
• Botulinum toxin use has shifted the application of endoscopic surgery towards specific cases of frontal ptosis.
• Combining procedures like upper blepharoplasty with peels and botulinum toxin can maintain rejuvenation results.

Implications:

• A multi-modal approach combining surgical techniques and non-invasive treatments offers enhanced and natural-looking forehead rejuvenation.
• Careful patient selection and technique refinement, such as transosseous suspension, are crucial for optimal forehead lift outcomes.
• Maintenance treatments like light peels and botulinum toxin injections can prolong the aesthetic benefits of facial rejuvenation procedures.