Carruthers Jean D A, Carruthers J Alastair
Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Dermatology, Carruthers Dermatology Centre, Vancouver, British Columbia, Canada.
Dermatol Surg. 2018 Nov;44 Suppl 1:S2-S4. doi: 10.1097/DSS.0000000000001688.
Worldwide, the brow is the most common facial site to receive aesthetic treatment. However, the forehead above the brows has been comparatively less well studied with respect to both neuromodulators and fillers. Age-related remodeling of the forehead with loss of facial bone has been demonstrated on detailed radiographic studies. Concurrent loss of facial fat deposits also adds to the volume depletion. The resulting shallow scalloped depressions in the central 2/3 of the forehead give a tired and aged appearance as do the deep etched horizontal forehead lines which are often associated. Temporal hollowing may be an important associated feature.
Combination treatment of the upper face with neuromodulators to elevate the brows and diluted hyaluronic acid (HA) fillers to smooth the medial glabellar complex and reflate the forehead and temple has recently become a desired and popular treatment. Several techniques have been described in the literature. All these techniques are designed to allow forehead reflation with reduction of the possibility of vascular compromise.
Avoidance of the supratrochlear and supraorbital vasculature with cosmetic filler injections is possible by insertion of needle or cannula into the subgaleal space above their transition from preperiosteal to subcutaneous level. Using this technique we have so far not seen any vascular compromise and we present this technique in the interest of patient safety.
在全球范围内，眉部是接受美容治疗最常见的面部部位。然而，就神经调节剂和填充剂而言，眉上方的额头相对研究较少。详细的影像学研究已证实，随着面部骨骼流失，额头会出现与年龄相关的重塑。面部脂肪沉积的同时流失也加剧了容量减少。额头中央三分之二处由此产生的浅扇形凹陷，以及常与之相伴的深深的刻痕状水平额头纹，都会让人显得疲惫和衰老。颞部凹陷可能是一个重要的相关特征。
用上半面部联合治疗，即使用神经调节剂抬高眉毛，并用稀释的透明质酸（HA）填充剂来抚平眉间复合体并使额头和颞部恢复饱满，最近已成为一种理想且受欢迎的治疗方法。文献中已描述了几种技术。所有这些技术的设计目的都是在减少血管受损可能性的情况下实现额头饱满。
通过将针头或套管插入滑车上血管和眶上血管从骨膜前向皮下水平过渡上方的帽状腱膜下间隙，可以避免在注射美容填充剂时损伤这些血管。使用这种技术，我们至今尚未见到任何血管受损情况，为了患者安全，我们在此介绍该技术。
