Transblepharoplasty forehead lift and upper face rejuvenation.

A complete upper face rejuvenation via blepharoplasty incisions is feasible. This technique is indicated in: (1) patients with male pattern baldness, (2) patients with a history of hair transplants, (3) patients with excessively high foreheads, (4) patients in which upper blepharoplasty is planned simultaneously with the brow lift, (5) patients with spastic frontalis syndrome, and (6) patients needing periorbital or bicularis muscle repositioning. Standard upper blepharoplasty incisions are made. Dissection is proceeded to the superior orbital rim. All the soft tissues, including the retro-orbicularis oculi fat (ROOF) pad, are elevated. A cuff of periosteum and the overlying subgaleal fascia is left. Superior dissection in the frontal area can proceed subgaleally or sub-periosteally. In the latter case, the periosteum is entered about 1.5 cm above the orbital rim. In the temporal area, dissection is done in the subgaleal plane up to 1 cm above the zygomatic arch. This dissection is accurately and safely done with the aid of the endoscope introduced through the same incision. Resection of the procerus and corrugator muscles is performed via the eyelid incision, identifying and protecting the supratrochlear and supraorbital nerves. Extra-fine-tip cautery is used for hemostasis. Initial fixation consists of suturing the ROOF pad to the periosteum of the orbital rim (two sutures). The tail of the brow is sutured to the temporal fascia (third suture). The frontotemporal flap can be stabilized in an elevated position with an external tied-over dressing, percutaneous screws, or well-supportive contouring tape, depending on the clinical situation. The eyelids are closed in a standard fashion. This operation was performed on 14 patients--12 with the assistance of the endoscope and in 2 without the endoscope. However, the endoscope has made the operation more precise. Analysis of the brow position, frontalis and corrugator activity, and the aesthetics of the upper face reveal that this operation can give results similar to other techniques with comparable morbidity, more expeditiously and with fewer scars.