Surgical treatment of forehead and glabellar wrinkles]

Many surgeons concerned with aging in the jowl and neck often overlook more objectionable changes in the upper face. These changes produce not only an old or aged appearance but inappropriate expressions as well. This paper outlines the elements of aging in the upper face and details the planning and execution of the foreheadplasty. Topics discussed include inappropriate facial expressions, upper facial aesthetics, incisions for bald or balding men and techniques for minimizing scars. For many years the evolution and application of techniques for rejuvenation of the upper face lagged behind that of procedures used to correct aging in the cheek and neck. Men were generally overlooked as candidates for foreheadplasties by surgeons who believed these procedures not to be possible on bald or balding scalps. In addition, patients were frequently disappointed after surgery due to objectionable secondary deformities. These include bizarre expressions from over-resection of forehead muscles, contour irregularities following imprecise muscle sculpturing, inappropriate appearances due to eyebrow malpositioning and aesthetic imbalances resulting from hairline shifting. For these and other reasons some surgeons deemed the procedure to be of questionable value. The author would like to share current concepts and new techniques which have overcome these problems and delivered satisfaction and happiness to many patients.