title: Morphometric long-term evaluation and comparison of brow position and shape after endoscopic forehead lift and transpalpebral browpexy.
abstract: BACKGROUND
  Although a multitude of proposed forehead rejuvenation procedures have been described, long-term and systematic morphometric evaluation is rare. There are no studies comparing endoscopic forehead lifts and transpalpebral browpexy techniques according to their efficacy in raising and reshaping the brow.
  
  
  METHODS
  In a retrospective study, standardized photographic documentations of patients undergoing an endoscopic forehead lift or a transpalpebral browpexy were morphometrically analyzed. Five measurements were taken to evaluate brow height, and two measurements were taken to describe the change in brow shape.
  
  
  RESULTS
  Fifty-six and 29 patients, respectively, in the two groups were analyzed up to 5 years postoperatively. Morphometric evaluation proved a significant elevation of the total brow and an improvement in brow shape for the endoforehead group, whereas the brow position after the transpalpebral browpexy significantly descends, despite an improvement in subjective aesthetic outcome. An additional blepharoplasty after the endoscopic forehead lift does not lower the brow significantly.
  
  
  CONCLUSIONS
  The efficacy of the endoforehead lift is supported by extensive, systematic, and long-term data, and its superiority over transpalpebral approaches has been proven. The descent of the brow after transpalpebral browpexy is most likely caused by a decrease of frontalis hyperactivity after the simultaneously performed blepharoplasty. Further studies need to evaluate its effect compared with blepharoplasty alone.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Freiburg, Germany From the Department of Plastic and Hand Surgery, University Medical Center Freiburg and Erich Lexer Clinic, and the Institute of Medical Biometry and Medical Informatics, University of Freiburg.
authors.forename: Niklas
authors.initials: N
authors.lastname: Iblher
authors.forename: Saskia
authors.initials: S
authors.lastname: Manegold
authors.forename: Christine
authors.initials: C
authors.lastname: Porzelius
authors.forename: G Björn
authors.initials: GB
authors.lastname: Stark
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D019882:Blepharoplasty; D004724:Endoscopy; D005138:Eyebrows; D005260:Female; D005500:Follow-Up Studies; D005546:Forehead / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010781:Photography; D012060:Rejuvenation; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*