Endoscopic Correction of Frontal Bossing
ABSTRACT : Frontal bossing is a displeasing prominence of the supraorbital area. Aesthetic correction has been described as an open surgical technique. This report introduces an endoscopic approach to correction.
: A retrospective review was performed on all patients who underwent endoscopic repair of frontal bossing from 2002 to 2009. Demographics, intraoperative and postoperative course, and outcome variables were collected. Standardized preoperative and postoperative photographs were used for analysis. Aesthetic improvement of the forehead was assessed with a four-point scale (1 = no improvement at all, 4 = significant improvement) by six randomly selected observers. Preoperative facial imaging (lateral skull radiography or computed tomography) was obtained on all patients to assess the thickness of the anterior wall of the frontal sinus.
: Ten patients met the study inclusion criteria. Overall, the observers assessed the degree of frontal bossing correction as moderate improvement (2.67 on a four-point scale survey). All endoscopic frontal bossing corrections were performed on an outpatient basis by the senior author (B.G.). No patient was admitted to the hospital for postoperative complications. No complications (such as alopecia, hematoma, contour deformities, or penetration into the frontal sinus) were seen. The limiting factor in achieving optimal outcomes was inadequate thickness of the anterior wall of the frontal sinus. All patients had various concurrent facial rejuvenation procedures.
: Endoscopic correction of frontal bossing is an effective and safe surgical technique in forehead aesthetics. This technique is ideal for patients with a mild frontal bossing deformity who have an adequately thick anterior frontal sinus wall.
: Therapeutic, IV.
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ABSTRACT: Forehead rejuvenation has an essential role in overall facial rejuvenation. Despite the evolution of rejuvenation techniques, principles of forehead rejuvenation remain the same. Circumspect facial analysis provides a crucial foundation in selecting the appropriate surgical technique and in optimizing the final aesthetic outcome. Today, myriad surgical options exist to address the senescent forehead. For example, the procedure can be performed through open, coronal, pretrichial, limited, or endoscopic incisions. The goal of this review article is to provide a simple and systemic approach to forehead rejuvenation. Common components of an aging forehead are reviewed. For each problem, a reappraisal of indications and efficacy of available surgical options is suggested. Of note, elevation of eyebrows on patients who have eyelid ptosis, proptosis, or deep tarsal crease should be avoided or carried out conservatively. It should often be performed in conjunction with ptosis correction and fat injection to the hollowed upper eyelid. On men with a receding hairline, the corrugator supercilii muscles are removed through the transpalpebral approach and the temple is lifted through two radial incisions and endoscopic dissection.Plastic & Reconstructive Surgery 09/2014; 134(3):426-435. DOI:10.1097/PRS.0000000000000483 · 3.33 Impact Factor