title: Finesse in forehead and brow rejuvenation: modern concepts, including endoscopic methods.
abstract: BACKGROUND
  The brow and forehead are essential elements of the facial aesthetic architecture. Although frequently overlooked in youth, signs of facial aging are often most noticeable in the upper third of the face. Ptosis and loss of contour in the brows, along with temporal volume loss, sagging of periorbital tissue, and rhytides in the forehead, are common presenting complaints for aesthetic surgery. Although use of nonsurgical procedures (e.g., neuromodulators) has become very common practice, knowledge of surgical anatomy and interventions for brow and forehead rejuvenation are critical for a plastic surgeon. The earliest descriptions of brow-lift procedures are nearly a century old. Techniques have evolved significantly, to the point that patients may now return to work within 1 week of surgery, with minimal or no stigmata from an operation.
  
  
  METHODS
  The literature and a series of cases from the senior surgeon (P.K.S.) were reviewed.
  
  
  RESULTS
  A minimally invasive approach with an endoscope for dissection and repositioning of the brow was used in all patients. The authors have found that permanent suture fixation with cortical tunnels can produce an excellent, long-lasting aesthetic result for not only the forehead and brow but also the lateral periorbital and temporal regions.
  
  
  CONCLUSIONS
  Although each operation is tailored to the patient's individual anatomy, the authors' approach to the endoscopic procedure is described in this article, along with a review of anatomical and surgical considerations. Finally, several patients provide demonstrative results from the senior surgeon's series of 546 patients.
authors.affiliation: Providence, R.I.; St. Louis, Mo.; Newark, Del.; and Palo Alto, Calif. From the Department of Plastic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University; the Division of Plastic and Reconstructive Surgery, Washington University; Premier Dermatology & Cosmetic Surgery; and the Department of Plastic Surgery, Palo Alto Medical Foundation.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Drolet
authors.forename: Benjamin Z
authors.initials: BZ
authors.lastname: Phillips
authors.forename: Erik A
authors.initials: EA
authors.lastname: Hoy
authors.forename: Johnny
authors.initials: J
authors.lastname: Chang
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005138:Eyebrows; D005260:Female; D005546:Forehead / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D012060:Rejuvenation; D015361:Rhytidoplasty / Q000379:methods*; D013536:Suture Techniques