Total permanent removal of wrinkles from the forehead

Temporal Branch Ablation for the Treatment of Facial Rhytids: A New Surgical Technique

BACKGROUND

Frontal wrinkles are a cause of distress for many people as they age. Traditionally, these have been treated with botulinum toxin injections. However, this procedure is not free from complications and has a temporary result. This report describes a procedure involving temporal branch of facial nerve ablation, a novel and simple technique for the treatment and prevention of rhytids.

OBJECTIVES

The objective of this study was to introduce this new technique of ablation for the treatment of frontal wrinkles after analyzing 3 options of approach based on the number of ablation lines.

METHODS

Fifty-one patients with a mean age of 49 years underwent nerve ablation. The temporal nerve branches were located through electrostimulation. Through a skin puncture in the temporal region, an Abbocath, with part of the plastic coating removed at its base, was introduced. The nerve branches were cauterized in oblique lines with a monopolar electric scalpel. Patients were divided into 3 groups, depending on the number of ablation lines.

RESULTS

The median follow-up period was 20 months (range, 1-50 months). Only 3 (5.7%) patients developed unilateral relapse of muscle activity in the frontal region. Group 6 was statistically superior to Group 1. There was no statistically significant difference between Group 4 and the other 2 groups. More than 70% of patients were satisfied or very satisfied with the results.

CONCLUSIONS

Facial nerve branch ablation is a simple surgical technique for the treatment of forehead rhytids that produces less postoperative pain, features rapid recovery, and, above all, offers long-lasting results.

LEVEL OF EVIDENCE: 4

Endoscopic Facial Rejuvenation: Endoforehead, the Functional Lift. Case Reports

Endoscopic techniques have only very recently been applied to aesthetic plastic surgery procedures, especially in carpal tunnel release, in forehead plasties , and in breast augmentation operations. The author briefly outlines his experiences with endoscopic forehead lifts, first reported at surgical conferences in Los Angeles and Buenos Aires in 1992, and now totaling 61 cases performed in the 11 months just prior to the submission of this article. This endoscopic approach to forehead lifting has provided similar and comparable results to conventional coronal forehead lift operations , by means of small incisions made in the scalp area with minimal and fewer complications.

Endoscopic facial rejuvenation: endoforehead, the functional lift. Case reports

Endoscopic techniques have only very recently been applied to aesthetic plastic surgery procedures, especially in carpal tunnel release, in forehead plasties, and in breast augmentation operations. The author briefly outlines his experiences with endoscopic forehead lifts, first reported at surgical conferences in Los Angeles and Buenos Aires in 1992, and now totaling 61 cases performed in the 11 months just prior to the submission of this article. This endoscopic approach to forehead lifting has provided similar and comparable results to conventional coronal forehead lift operations, by means of small incisions made in the scalp area with minimal and fewer complications.

The forehead lift: techniques to avoid complications and produce optimal results

This discussion of forehead lifting, based on modifications of Vinas, Caviglia, and Cortinas, shares the authors' methods of patient evaluation, diagnostic details, architectural planning, and surgical concepts for forehead rhytidectomy along with correction of malpositioned and ptosis of the eyebrows and also glabellar frown problems. In addition, the nasal deformities associated with the sagging of the skin and subcutaneous tissue onto the upper fourth of the nose may make the nose look too short for a pleasing balance of the face and the upper fourth may appear disagreeably wide. A contribution to this excessive width is made by a sometimes thick and wide procerus muscle along with bilateral thick depressor supercilii muscles. When this nasal deformity is corrected, glabellar frown problems are also corrected. Attention to the details of the above-mentioned factors results in very long-lasting, sometimes permanent, and almost complication-free results that please the surgeon and the patient. Complications such as adherence of the dermis to the underlying pericranium, lack of motion in a portion of or the entire forehead, hyperactivity around areas of immobility, muscle irregularities, and also surgically produced depressions which require grafting, skin sloughing, permanent nerve injury, persistent sensory nerve loss, and short-term improvement have been avoided by paying attention to diagnosis, surgical planning, and technique, and postoperative care. Most patients can return to work in four or five days with minimal discoloration and swelling if they have not had aspirin or vitamin E one month before surgery, and there is hemostasis and the use of drains when indicated. Minimizing detection of the surgical incisions is accomplished by detailed preoperative planning of their location, architectural design development and drawing at the time of surgery, special surgical techniques, and excision of the skin or scalp. For patients with male pattern baldness use of specially designed V-Y advancement flaps with the browlift procedure improve the appearance of the hair's thickness and distribution.

Complications of the forehead-brow lift

The actual and possible sequelae and complications associated with a series of forehead-brow lifts are reviewed. Based on a review of the records of 61 patients who underwent the procedure, we recommend that the forehead-brow lift be primarily intended to correct soft tissue ptosis of the upper face. Because of the significant number of patients who required a revision upper blepharoplasty, this procedure either should not be combined with a brow lift, or the patient should be warned of the probable necessity of a later revision upper blepharoplasty.

An update on blepharoplasty

An integral perspective of the aging eyelid is presented. A classification into three different degrees of aging is done, according to gravitation and excess skin present. The surgical techniques for third-degree aging are described, and a ten-year bibliography is presented to show the reader the interest that this anatomical region has had in the medical profession.

The history of rhytidectomy

CONCLUSION

Between Cantrell [23] and Cabanès [21] in the first decade of this century and the many practitioners of contemporary rhytidectomy, the concerns and labors of aesthetic plastic surgeons have a familiar tone. We have inherited their improvements and need not waste efforts which theirs have spared us in techniques. Only if we are also the grateful heirs of their subjective scientific and humanistic ideals can we carry forward surgical research to the goals implicit in their pioneering-the safe and effective prolongation of youth and retardation of aging.The evolution of aesthetic plastic surgery to its present status as a rigorously controlled medical technique received its power from the perennial drive of men and women to preserve the appearance of their body and face in consonance with the vigor of their personalities and desires. We have always known that inner psychic and spiritual changes bring about a new external radiance, but we are now discovering that the process also works in reverse: Change the external appearance-restore the lost years-of a person struggling continually against indifferent or negative social reactions, and the inner light that has died within begins to glow once more.

Surgical correction of forehead wrinkles, glabellar frown, and ptosis of the eyebrows

Lasting elimination of forehead wrinkles and glabellar frown may be achieved by a partial resectioning of the muscles of the forehead. In those cases in which the eyebrows are also lifted, we use a line of incision which is similar to the blepharoplasty of the upper lids used by Morel-Fatio. We carry out the resectioning of the muscle more extensively than is generally described in the literature. It has hereby been observed that the partial resectioning of the musculus frontalis leads to a smoothing out of the horizontal forehead wrinkles, without a tightening of the skin. The results were always satisfactory both for the patients and the surgeons, and the rate of complication was minimal. A result acceptable to the patient can be achieved only if she has been thoroughly informed in advance.