Endoscopic foreheadplasty : Temporary vs. permanent fixation

The introduction of fiberoptic endoscopes has fostered the development of minimally invasive aesthetic facial plastic surgery. The application of this new technology is most widely used in rejuvenation of the mildly to moderately ptotic brow. The concept of endoscopic foreheadplasty is based upon the following maneuvers. First, a sub- or supraperiosteal dissection of the parietal, occipital, and frontal scalp to the level of the superior and lateral orbital rims and zygomatic arch must be accomplished. Second, incision and release of the superior and lateral orbital periosteum are performed. Third, selective myotomies of the brow depressor muscles are completed. These maneuvers allow the brow to be permanently elevated into a desired position following fixation and healing. A significant limitation of this procedure appears to be the ability to predict the long-term forehead and brow elevation. We believe that permanent fixation is one of the best methods to ensure that the desired elevation is maintained. We contrast two series of patients, one with temporary fixation technique and the other with permanent fixation. We review the results and discuss the rationale and advantages of permanent fixation.