射频手术机器辅助内窥镜骨膜下额颞部除皱术

目的探讨射频手术机器在内窥镜骨膜下额颞部除皱术中的应用。方法常规内窥镜骨膜下额颞部除皱术中,应用射频手术机器切割及凝固电极行骨膜下剥离,尤其是眶周和额颞移行区充分分离,仔细分离切割皱眉肌、降眉肌及部分额肌,松弛皮肤钛钉固定于颅骨外板。结果本组10例均获得满意效果。结论射频手术机器辅助内窥镜骨膜下额颞部除皱术,能准确分离切割额颞部肌肉,除皱效果确切、持久。     

Safety and efficacy of combined upper blepharoplasties and open Coronal Browlift: A consecutive series of 600 patients

Surgical rejuvenation of the upper face involves the correction of excess and lax forehead, eyelid, and periorbital skin. Improving the appearance by correcting the effects of aging involves a combination of blepharoplasty and open coronal foreheadplasty. Many surgeons and several reports question the safety of both procedures being performed concomitantly. The difficulty arises in precisely balancing the skin excision from the frontal forehead and upper eyelid areas. Over-resection of skin may result in incomplete closure of the eyelid and dry-eye syndrome, while an inadequate resection may produce a poor aesthetic result. There is no large series that documents the safety and effectiveness of these two procedures being performed concomitantly. Furthermore, with the recent and rapid development of complex multiplanar endoscopic facial rejuvenation techniques, the basic open forehead-plasty has become increasingly overlooked as a legitimate, efficacious technique for rejuvenation of the upper face. The technique utilized in this series is presented in detail. The consistently excellent results obtained satisfy the aesthetic goals of patients as well as the goals of surgeons, and suggest a renewed interest in the technique based upon its simplicity and easily reproducible results.     

Transblepharoplasty brow suspension: an expanded role

Brow position and hyperfunction of the muscles of forehead facial expression contribute to the aging diathesis of the upper one third of the face. In many cases, the eyelids and brows are addressed together to achieve a satisfying rejuvenation effect. Many different approaches to the brow are used, including the long coronal or pretricheal incisions, direct incision of the suprabrow or forehead, and finally the use of smaller incisions with an endoscopic technique. Another technique, deserving of further consideration, is the transblepharoplasty brow lift (TBBL). Though generally reserved for occasional use, this technique is easy to perform, minimizes facial incisions and operative time, and can achieve results comparable to other, more extensive, approaches.     

Endoscopic forehead lifting and contouring

The concept of endoscopic foreheadplasty is based upon a sub- or supraperiosteal dissection of the parietal, occipital and frontal scalp, incision and release of the superior and lateral orbital periosteum, selective myotomies of the brow depressor muscles, and brow elevation into a desired position with fixation and healing. A significant limitation of this procedure appears to be the ability to predict the long-term forehead and brow elevation. We review the anatomy relevant to forehead rejuvenation surgery and present our surgical technique for permanent fixation endoscopic forehead lifting. We discuss the scientific rationale for permanent fixation to ensure long-term forehead and brow position and draw our conclusions based upon the results of animal and clinical studies that have been completed.     

Bicoronal forehead lift

Although aesthetic surgery on the upper third of the face has received relatively little attention in recent literature, it is an extremely important component of facial aesthetic surgery and often yields results that are quite dramatic. Periorbital rejuvenation, either alone or in conjunction with other aesthetic surgical procedures, offers facial enhancement to younger patients. In addition, older patients may benefit from a forehead lift performed in conjunction with lower facial surgery. This benefit is derived because lower facial surgery may create facial disharmony by yielding a more youthful lower face while leaving a more mature upper face. In these cases a forehead lift serves to unify the patient's facial appearance. The coronal browlifting technique described here is a personal interpretation and modification of periorbital rejuvenation techniques. This approach represents an ideal aesthetic procedure: It is a technically straightforward operation that yields results which are predictable, natural appearing, and long lasting with minimal morbidity.     

内镜除皱术26例报告

目的：总结回顾利用内镜除皱使面部年轻化的手术经验。方法：从1994年开始到2000年底分别利用国产和进口整形外科用内镜和关节镜开展额颞部除皱手术26例,采用额部小切口,在额部、眶周和头顶进行广泛的帽状腱膜下和骨膜下分离,采用缝线和螺钉固定向后滑行的头皮和额部皮肤。结果与结论：全部患者取得了比较好的效果,无并发症发生,与传统的开放除皱术相比较,内镜除皱技术具有解剖清晰、创伤小、出血少、恢复快等优点。本方法适用于轻度和中度的额颞部和眶周皱纹的处理。     

A Simple Device for Incision Retraction and Protection in Endoscopic-Assisted Brow and Forehead Lifting

BACKGROUND: Endoscopic-assisted cosmetic surgery has revolutionized various procedures. Forehead and brow lifting performed with endoscopic technique has been shown to be predictable and has fewer complications than open techniques. Providing surgical access and protecting the hair follicles is paramount in endoscopically assisted brow and forehead lifting. OBJECTIVE: To describe a simple retraction device to assist in incision retraction and protect hair follicles. METHODS: A simple, inexpensive retraction device is described that has been used in 60 endoscopic brow incisions to effectively protect the hair follicles and retract incisions for operative techniques. In addition, other methods of follicular protection are discussed. RESULTS: Decreased incisional alopecia and improved surgical access are provided by the use of a simple retraction device and attention to follicular preservation. CONCLUSION: Endoscopic-assisted brow and forehead lifting is becoming the preferred method of upper facial rejuvenation. There is a steep learning curve and often the lack of attention to hair follicle protection results in localized incisional alopecia. In addition, improper surgical access complicates the procedure. A simple device is described to assist in retraction and follicular preservation.     

Endoscopic forehead lift

Endoscopic forehead rejuvenation offers the advantages of greater patient acceptance and lower complication rates. The author describes technical modifications that make the endoscopic approach effective in a wide range of patients. Particular attention is paid to the problem of asymmetry. When the preoperative difference in eyebrow height exceeds 6 mm, it is a matter not only of eyebrow asymmetry but also, and more importantly, of forehead asymmetry. Surgical and fixation techniques are discussed for correction of the asymmetric forehead, glabellar frown lines, transverse furrows, and radix folds.     

内镜额部除皱术结合传统切开法除皱的效果

目的探讨内镜除皱术与传统除皱术相结合的治疗方式及效果。方法仅存在额部皱纹、眉间纹及眉下垂者采用内镜额部除皱术,切除或切断皱眉肌、降眉肌和额肌,必要时结合额部皮瓣上提悬吊技术即可;如同时存在中下面部皮肤老化、松弛下垂,则内镜额部除皱术尚需结合传统切开法的中面部或中下面部除皱术,做浅表肌腱膜系统（sMAs）筋膜的折叠或切除缝合,以及多余皮肤的切除剪裁。结果104例采用额部内镜除皱术,均取得良好的除皱和眉提升效果。并发症较少而轻微,包括表情肌去除部位的轻度凹陷、额部皮肤麻木、发际线轻微后移、皱纹去除不彻底等。无面神经颞支损伤等严重并发症发生。其中84例存在中下面部皮肤松弛下垂,在做内镜额部除皱的同时行耳前切口的传统除皱术,明显改善中下面部的皮肤老化,并使面部上下的年轻化协调一致。结论内镜额部除皱术设计合理、操作安全、效果明确,是一项切口小、损伤轻的微创技术,符合整形外科的发展趋势。对于同时存在有中下面部皮肤松弛者,如能结合传统切开法除皱术,面部年轻化的整体效果可进一步优化。     

Facial rejuvenation: A combined conventional and endoscopic assisted lift

This article describes our personal approach for facial rejuvenation combining conventional and endoscopic procedures. For a forehead lift we use an endoscopic assisted technique. However, for the face and neck we still prefer the conventional lift. Good candidates for subperiosteal endoscopic midface lifts without skin resection are young or middle-age patients with midface ptosis and pronounced nasolabial/nasoyugal folds, without significant skin excess. Ptosis of the temporo-malar or facial area is also a good indication for subcutaneous endoscopic assisted lift. Aesthetic improvement of the forehead is evaluated with objective data of preoperative and postoperative measurements. We find this minimally invasive technique less traumatic and time consuming. It allows a greater range of possibilities for individual needs because it limits the incision and dissection to the required areas and has a higher level of acceptance by the patients. It is also a good complement to a conventional face lift.     

An alternative fixation technique for the endoscopic brow lift

BACKGROUND: Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow, since only 3 hardly noticeable incisions of the scalp are needed for this subperiosteal dissection and final repositioning of the brow. It has become an acceptable technique, an alternative to the conventional technique or transcoronal browpexy. One of the controversial points is the fixation of the flap in the elevated position. METHOD: Endoscopic brow lift allows separation and repositioning of the periosteum of the orbital rims and zygomaxilla. In a 6-year period from September 1999, 300 patients underwent endoscopic brow lift using our fixation approach, which was accomplished with an absorbable suture subperiosteally. RESULTS: Satisfactory forehead rejuvenation was obtained in all patients, with correct eyebrow movement. CONCLUSIONS: Long-term results of 6 years confirm the strength and durability of this fixation approach. We consider this approach to be a simple, secure, and reliable forehead fixation method, an alternative to other fixation methods, that allows satisfactory and long-lasting cosmetic results.     

Subperiosteal transblepharoplasty forehead lift

Contemporary options for correction of the aging upper one-third of the face include open techniques with a coronal or anterior hairline incision, endoscopic access to the forehead including muscle transection, brow lift through direct forehead skin excision and various forms of brow-pexies. Realizing the common need for aesthetic improvement in the upper eyelids and desiring minimal incisions for forehead rejuvenation, an approach through the blepharoplasty incision has been developed which addresses all of the components of the aging upper third of the face: A combined subperiosteal approach for forehead elevation and transection of corrugator and procerus muscles through the blepharoplasty incision is presented. The postoperative improvements in the position of the brow as well as improvement in the glabellar area rivals other approaches and allows simultaneous improvement in upper eyelid aesthetics.Presented at the Annual Meeting of The American Society for Aesthetic Plastic Surgery, Inc., March 1995 and at the 13th International Congress of The International Society of Aesthetic Plastic Surgery, September 1995     

Modifications in endoscopic facelifts.

Since 1996, 72 patients (66 women and 6 men) have undergone endoscopic upper and midface rejuvenation. Sixteen of these patients had concomitant lower face rejuvenation at the same time. The patients were operated using a personal endoscopic technique, including biplanar endoscopic dissection (subgaleal and subcutaneous) at the forehead and temporal regions, excision of a galeal strip approximately 1 cm in thickness (to achieve a stable forehead lift), and a lower blepharoplasty incision for midface lifting and fixation of the malar fat pad. This approach helps to prevent midface widening-a concern of most surgeons. Regarding patient satisfaction, 51 patients had excellent results, 16 patients had good results, and 5 patients had an improved appearance of the mid and upper face. Complications included 11 incidences of temporary numbness in different regions of the upper and mid face, three incidences of temporary lower lid retraction (which did not require additional revision), three relapses of eyebrow elevation (which were reoperated), and unbalanced eyebrows in 2 patients (which were corrected during secondary revisional procedures).     

Optimal forehead rejuvenation. Combining endoscopy-peel-botulinum toxin

The combining of a traditional resurfacing technique (trichloracetic or phenol peel) with 2 recent technological advances (endoscopic forehead plasty, botulinum toxin) may enhance the forehead rejuvenation in a more natural way. The disappointing results of some of our earlier results on a serie of 70 consecutive foreheadplasties can probably be attributed to the weakness of the suspension through percutaneous sutures. This has been remedied since 1998 by the systematic use of transosseous suspensions. The growing success of botulinum toxin explains the noticeable decrease of endoscopic surgery. This type of procedure is now used to correct significant frontal ptosis requiring an uplifting of no more than 1,5 cm, thereby avoiding the unnatural results encountered in many publications. Some benefits can be obtained by the way of a transpalpebral approach without using the endoscope; nowadays, upper blepharoplasties are almost systematically done in the majority of our cases in order to obtain the most natural result. Light peels and botulinum toxin injections can maintain this result relatively easily.     

Evolution in techniques for endoscopic brow lift with deep temporal fixation only and lower blepharoplasty-transconjunctival fat repositioning

As we become more confident with our surgical skills following our fellowship training, some of our approaches and techniques will be modified or changed. My primary evolutionary change involves procedures of the upper third of the face, primarily the brow lift and treatment of lower eyelid fat techniques. Traditional methods of forehead and brow rejuvenation, such as coronal, pretrichal, and direct brow lifts, have provided facial plastic surgeons with effective brow elevation for many years. In the past decade, the endoscopic brow lift has rapidly become accepted as part of the surgical armamentarium and is frequently the technique of choice. In general, the temporal dissection, temporal fixation, forehead subperiosteal or subgaleal dissection with release, and treatment to the brow depressor musculature have been standardized. Methods of bony fixation remain a controversial topic as there are numerous methods. We advocate deep temporal fixation only without bone fixation to achieve effective, long-term brow elevation. Traditionally, lower eyelid herniated fat is removed, which may cause a sunken or hollow lid appearance, especially in patients with a tear trough deformity (nasojugal groove). Lower eyelid transconjunctival fat repositioning, defined as the subperiosteal repositioning of the medial and central lower eyelid herniated orbital fat into the nasojugal fold, may prevent the surgical, hollow lower eyelid appearance while treating the herniated fat. Fat repositioning may be combined with an endoscopic subperiosteal midface-lift, transcutaneous skin pinch, and transconjunctival orbicularis oculi excision. This technique offers a powerful tool in the surgical armamentarium of the facial plastic surgeon.     

Endoscopic full facelift

This article demonstrates the efficacy of endoscopic techniques in total facial rejuvenation. The author has introduced the total subperiosteal dissection to the endoscopic forehead lift. This concept has been extended to the rejuvenation of the central and lower third of the face. Patients up to the late 40s can have a total facelift without skin excisions. In older patients, the introduction of endoscopic techniques helps to minimize some of the undesirable sequelae of the traditional open procedures such as alopecia, scalp paresthesias, and facial edema of the subperiosteal lift. The author also introduces a new, more efficacious method of midface suspension.     

Endoscopic facial surgery

The emergence of endoscopically assisted cosmetic surgery has been very rapid. Public demand has burgeoned this trend resulting in the widespread use of these techniques prior to their proven efficacy. Fortunately, the results to date are favorable. The endoscopic brow and forehead lift appear to be as reliable as the open coronal approach while inflicting less incisional morbidity and decreased postoperative recovery time. This combination of decreased morbidity and post surgical discomfort have led to increased patient acceptance of browlifting. The soft-tissue orbital complex is composed of the eyebrow, upper and lower eyelids, and the malar prominence. When used in conjunction with blepharoplasties, the endoscopic browlift and midfacial suspension dramatically improve the appearance of the eye when compared to blepharoplasty alone. The applied surgical anatomy, indications, and operative technique used in endoscopic upper facial rejuvenation are detailed. Surgeons who are not utilizing the endoscopic techniques are encouraged to do so when repositioning the eyebrow and malar prominence would improve the aesthetic result.     

Stirnlift

Background

Worldwide the demands for anti-aging surgery have grown. Additionally, the patients’ demand for minimallyinvasive operative procedures for effective, facial rejuvenation has increased. The clear trend is toward endoscopic procedures with high effectiveness. Facelifts, which can be categorized into forehead lifts, midface lifts and neck lifts are effective methods for facial rejuvenation. The forehead lift focuses on the patient’s youthful appearance of the forehead and eyebrow region. In this context, the new static and functional position of the eyebrows is of great importance for the postoperative appearance and satisfaction of the patients. The choice of the operative procedure is dependent of the forehead anatomy and the individual expectations of the patients.

Methods

This article combines a literature search with the personal experiences of the authors regarding forehead surgery.

Results

The characteristic signs of the aging forehead that are addressed with the forehead lift are ptotic eyebrows, transverse forehead skin lines and vertical/oblique/transverse glabellar skin lines. Over the last decades, the forehead lift with a long incision posterior to the frontal hairline or in the frontal hairline (hairline cut, which is also used in cases of an extended facelift) were the commonly used operative methods. Today, the clear trend is towards minimallyinvasive procedures performed using shorter incisions. The endoscopic approach has revolutionized aesthetic forehead surgery; however, the safe and reliable application of the endoscopic technique depends on the technical expertise with the endoscopic equipment and the specific operative procedure.

Conclusion

The endoscopic forehead lift is an effective method to recover the patient’s youthful appearance. Over the last decades, the forehead lift with a large incision posterior to the frontal hairline was the commonly used operative method; however, worldwide the clear trend is toward minimally invasive procedures.

     

Effects of subperiosteal midfacial elevation via an endoscopic brow-lift incision on lower facial rejuvenation

Many techniques have been developed for rejuvenation of the midface. This article describes the technique of subperiosteal midface elevation via an endoscopic brow incision approach developed by the senior author and reviews the results of this technique, with specific emphasis upon the effect on lower facial rejuvenation.     

Comprehensive periorbital rejuvenation with resorbable endotine implants for trans-lid brow and midface elevation

Periorbital rejuvenation can enhance a patient's appearance, with changes of only a few millimeters making a significant impact. Many patients undergoing blepharoplasty often have mild brow or midfacial changes for which they are unwilling to undergo additional concurrent forehead or midface procedures, however, because these procedures may be associated with an unacceptable postoperative recovery and may not provide adequate tissue fixation. This article describes limited incision procedures capable of providing excellent elevation and support to the brow and midface that can be incorporated easily into a comprehensive periorbital rejuvenation treatment plan using semi-permanent subperiosteal fixation devices.