Endoscopic Forehead Lift for Decreasing the Frown Line:A New Approach

In certain cases of endoscopic forehead lift with no muscle resection, it has been found that, although the muscles remained intact, patients lost or developed weakness in their frowning ability after the operation. This finding persuaded the authors to try to eliminate or decrease the sensory problems of open or endoscopic frowning muscle resection by dis-inserting these muscles. We also sought to determine the efficacy of a brow/forehead lift that did not involve muscle resection. In a case series of 18 patients, small scalp incisions were used to elevate the brows/forehead and perform glabellar and forehead muscle dis-insertion. The majority of patients achieved an aesthetically pleasing eyebrow and forehead lift, with reduced power in the frowning muscles. In these patients, we observed a significant decrease in the depth of vertical and horizontal glabellar creases in 14 of 18 patients. [success ratio=0.871, with 95% confidence interval (0.753, 0.989)]. Dis-insertion, but not resection, of corrugator supercilli, procerus, or orbicularis occuli muscles can decrease the power of contraction, with a smaller chance of damaging the forehead sensory nerves intermingled in these muscles.