Roberts T L, Ellis L B
Medical University of South Carolina and the Spartanburg Regional Medical Center, USA.
Plast Reconstr Surg. 1998 Apr;101(4):1075-84. doi: 10.1097/00006534-199804040-00030.
Coronal foreheadplasty has long been the traditional method of improving the aesthetic appearance of the forehead, permitting not only repositioning of ptotic tissues but also direct access for modification of the "frown" muscles. However, it was only moderately successful in eliminating vertical corrugator lines or deeply etched transverse wrinkles. The recent advent of the endoscopic brow lift has permitted us to minimize the dysesthesias associated with the coronal approach by making the incisions shorter and radially oriented and by being more precise in the muscle resection. Nonetheless, endoscopic brow lift gives no further improvement in persistent deep vertical and transverse wrinkles. Carbon dioxide laser resurfacing can improve the existing wrinkles but does not eliminate the muscular cause of forehead wrinkles. It seemed reasonable that combining these techniques might yield better results than either procedure alone. To evaluate this possibility, 30 patients with simultaneous endoscopic brow lift and carbon dioxide resurfacing were compared with 24 patients having laser resurfacing only and with 26 patients who had traditional coronal foreheadplasty. Both foreheadplasty groups had corrugator resection. All patients were evaluated at least 4 to 6 months postoperatively. Ratings were based on the percent of wrinkles removed, both vertical and transverse. The ratings were performed with predetermined criteria by a surgeon not involved with the operative procedures nor after care. A rating of "excellent" (> or = 95 percent reduction in wrinkles) was obtained in 50 percent of coronal foreheadplasties; 41.7 percent of carbon dioxide resurfacing alone and 80 percent of endobrow lifts with carbon dioxide laser resurfacing. There was no vascular compromise from this latter combination of procedures, no hypertrophic scars, and no impairment of healing. We conclude that endoscopic brow lift with carbon dioxide laser resurfacing is a safe and perhaps more effective means of aesthetic rejuvenation of the forehead.
冠状前额整形术长期以来一直是改善前额美学外观的传统方法，它不仅能重新定位下垂组织，还能直接对“皱眉”肌进行调整。然而，在消除垂直的皱眉纹或深深的横向皱纹方面，它的效果仅为中等。最近出现的内镜下眉提升术使我们能够通过缩短切口并使其呈放射状以及在肌肉切除时更加精确，从而将与冠状入路相关的感觉异常降至最低。尽管如此，内镜下眉提升术对于持续存在的深层垂直和横向皱纹并无进一步改善。二氧化碳激光磨皮可以改善现有的皱纹，但无法消除前额皱纹的肌肉成因。将这些技术结合起来可能会比单独使用任何一种方法产生更好的效果，这似乎是合理的。为了评估这种可能性，我们将30例同时进行内镜下眉提升术和二氧化碳磨皮的患者与24例仅进行激光磨皮的患者以及26例进行传统冠状前额整形术的患者进行了比较。两个前额整形术组均进行了皱眉肌切除术。所有患者在术后至少4至6个月接受评估。评分基于去除的皱纹百分比，包括垂直和横向皱纹。评分由一名未参与手术操作及术后护理的外科医生按照预定标准进行。在冠状前额整形术中，50%的患者获得了“优秀”评分（皱纹减少≥95%）；单独进行二氧化碳磨皮的患者中这一比例为41.7%，而在内镜下眉提升术联合二氧化碳激光磨皮的患者中为80%。后一种联合手术方式未出现血管损伤、增生性瘢痕，也未影响愈合。我们得出结论，内镜下眉提升术联合二氧化碳激光磨皮是一种安全且可能更有效的前额美容年轻化方法。
