Forehead and scalp sensation after brow-lift: a comparison between open and endoscopic techniques

To compare postoperative forehead and scalp sensation for the "open" brow-lift (OBL) (coronal and trichophytic) with that of the endoscopic brow-lift (EBL).

A controlled outcome evaluation study was designed to objectively (mechanoceptive and thermoceptive) and subjectively (visual analog scale) test forehead and scalp sensation in a group of patients having undergone or scheduled to undergo either OBL or EBL in a single, private facial plastic surgery clinic. Prospectively enrolled participants were tested at defined intervals (A, preoperation; B,1-2 weeks after; C, 4-6 weeks after; D, 12-14 weeks after; and E, 24-26 weeks after). To provide extended follow-up data (≥6 months), patients returning for scheduled follow-up examination who had already undergone either OBL or EBL were subjected to the same test battery. For statistical analysis of the extended follow-up data, the participants were divided into 2 groups (F, 6-18 months; and G, >18 months). The null hypothesis was that there would be no measurable difference between the OBL and the EBL groups related to postoperative forehead and scalp sensation.

Twenty-one individuals (EBL, n = 11; OBL, n = 10) were enrolled prospectively. All showed normal objective and subjective values preoperatively. While both groups objectively and subjectively demonstrated decreased sensation over follow-up, the OBL group showed statistically significant decrement in objective scalp sensitivity at times B, C, and D vs the EBL group. Subjectively, the OBL group felt less sensitive than the EBL group at times C and D. Those relationships disappeared at time E. Fifty-eight individuals were retrospectively enrolled. At time F (EBL, n = 16; OBL, n = 10), an objective and subjective difference was again observed with the OBL group demonstrating less scalp sensitivity vs the EBL group. At time G (EBL, n = 20; OBL, n = 12), this difference was no longer observed.

We reject the null hypothesis and state that there is a measurable, statistically significant difference between the studied groups related to postoperative forehead and scalp sensation and that those observed differences are objective and subjective in nature as well as time dependent. However, almost no patients (57 of 58), irrespective of the technique used for their brow-lift, viewed their experienced forehead and/or scalp numbness to have been significant enough to deter them from undergoing the surgery again.