Forehead and brow rejuvenation: definition of a surgical algorithm

Background Ptosis of the eyebrows, or a very high and wrinkled forehead, may be found in both young adults and the elderly. Static wrinkles can be effectively addressed by surgery in which the approach varies from endoscopic to open procedures. The absence of a unanimously accepted treatment algorithm creates difficulty in selecting the best option in every case. The aim of this study is to find the optimal treatment, given differently featured patients who are all seeking forehead rejuvenation. Methods We carefully reviewed the literature on forehead and brow rejuvenation. Furthermore, 123 brow lift cases in the first author’s practice have been analyzed; as such, the algorithm we proposed here was applied. Results In a 10-year follow-up period, seven endoscopic cases have shown relapse. Scarring, the inevitable outcome of any surgical procedure, resulted in pathology in two cases, necessitating a “touch-up” to ameliorate some aesthetic issues. The relatively low complication rate suggests that proper indications have been conveyed; our algorithm demonstrated a high degree of effectiveness. Conclusions According to our experience, each technique is more applicable for certain patients. In this sense, our updated algorithm should be extremely helpful to young surgeons who are willing (and technically able) to handle forehead rejuvenation cases. Level of Evidence: Level V, therapeutic study.