Forehead and Brow Rejuvenation Flashcards
An isolated upper blepharoplasty performed in
the presence of brow ptosis can over time worsen that problem Why?
as frontalis tone decreases with the elimination of the compensatory stimulus provided by hanging upper lid skin, resulting in
increased brow ptosis
It has also been noted that sagging glabellar skin can make
the nose appear foreshortened; this phenomenon, in combination
with a nasal tip elongated with age, can give the illusion of a nose
situated too low on the face
T
The
intersection of a vertical line drawn at the alar base and the supraorbital rim represents the medial extent of the brow.
T
the brow
peaks (0.5-1 cm above the rim in women and at the height of the rim
in men) at the junction of the middle and lateral third of its width
T at the lateral limbus.
may be more desirable for the brow to reach its vertical peak closer to
the lateral canthus.
T
temporal branch of the facial nerve, and this is the only motor nerve at risk during a brow lifting procedure
T
The temporal branch runs in the temporoparietal
fascia and can be avoided by»»>
adhering to the deep temporal fascia
during dissection and remaining more than 1.5 cm above the lateral orbital rim
Staying in the subcutaneous plane while dissecting
the forehead avoids any possibility of motor nerve injury
T
Sensory innervation for the brow
The first two branches of the trigeminal nerve, the supraorbital nerve and
the supratrochlear nerve, supplies sensory innervation to the brow
The supratrochlear nerve fibers are found in the substance
of the corrugator muscle approximately 8 to 12 mm medial to the
supraorbital nerve
T
the supratrochlear nerve plays a far
more significant role in brow innervation than supraorbital
nerve
F The supraorbital nerve plays a far
more significant role in brow innervation than the supratrochlear
nerve
fat plays
little role in the aging process of the brow why?
There is minimal adiposity in the brow
volume redistribution of the fat does not enter into the discussion of brow rejuvenation
techniques
T
the lateral temporal fat pad can descend and contribute to a ptotic brow appearance
T
sentinel vein, a structure that lies 1.5 cm
superior and lateral to the lateral canthus
T
What is the benefits of sentinel vien
represents an important landmark, as it can be used to establish the
position of the temporal branch of the facial nerve (1 cm lateral and
inferior to the sentinel vein) as well as the temporal line of fusion at
the temporal crest
a frown-muscle imbalance results in glabellar creases and central
forehead furrows.
T
gravity and the relatively stronger depressor muscles overpower the weaker brow elevators
T
Compensatory frontalis hypertrophy may result,
yielding transverse forehead rhytids.
T
muscle activity and imbalance of that activity over time play a greater
role in the appearance of the brow in aging
T
brow rejuvenation procedures are focused more on rebalancing the
underlying muscle equilibrium and repositioning ptotic tissue
T
The presence of compensated brow ptosis must also be
ruled out prior to performing an upper blepharoplasty
T
horizontal forehead rhytids at rest. These lines are indicative
of a requirement for frontalis contraction to maintain brow height at
baseline
T
The diagnosis of compensated brow ptosis
is confirmed by
having the patient close his or her eyes. If the frontalis relaxes and
the brow drops, compensated brow ptosis is present.
Isolated brow lifting procedures
can unmask unrecognized upper eyelid ptosis and contribute to an
appearance of deep set eyes.
T
Vertical glabellar rhytids are caused by horizontal contractions of
the corrugators,
T
efficacy of botox is more rapidly
lost in males
T
The concept of a chemical brow lift produces minimal brow
elevation and is based on deactivating the depressors (corrugators,
orbicularis oculi, and central frontalis muscles)
T
An open brow lift options
via a coronal (gull-wing)
approach or modified centrally to the widow’s peak hairline (anterior
approach)
in patients with a wide forehead. The anterior approach will
improve the appearance of a wide forehead
T
In patients with a wide forehead, defined as greater than 5 to 6 cm
from hairline to brow, a hairline incision is used. In patients with
normal brow width, a coronal incision is utilized and excess tissue is
excised from the hair-bearing scalp
T
In patients
with hyperactive frontalis muscles, a wedge of frontalis is marked
and excised between the supraorbital nerves to preserve underlying fat
T
The wound is closed with staples
in the temporal hair and in two layers centrally
T
advantages of endoscope
reduced
scar burden, decreased risk of scalp paresthesias, and diminished
postoperative edema
multiple strategies of scalp flap fixation exist, most would agree that the periosteum reattaches to the mobilized scalp flap rapidly regardless of the method of fixation that is employed
T
Although the endoscopic brow lift effectively addresses central
forehead and glabellar rhytids, lateral ptosis and crow’s feet are not as
readily addressed with this procedure
T
a high hairline or an acutely sloped
forehead can make this procedure technically difficult to perform
T
Disadvantage of endoscope
can’t address the lateral brow and crows feet
a high hairline or an acutely sloped forehead can make this procedure technically difficult to perform
The degree of muscle disruption necessary to achieve the desired result
can be more difficult to judge
prone to corrugator over-resection and resultant widening of the space between the eyebrows
The endoscopic approach
is especially suited to individuals with a low brow position, as the
forehead with properly toned musculature can be expected, after
wide elevation
T
Benefit of endoscope
reduced
scar burden, decreased risk of scalp paresthesias, and diminished
postoperative edema
A medial subgaleal brow lift with corrugator muscle excision and procerus disruption can be done alone or in combination with a lateral temporal brow lift in patients with a low medial brow
T
No dressing is used in direct temporal brow lift
T
The lateral temporal lift produces long-lasting results
T
The midpupillary line, approximately 3.5 cm lateral to the midline, is then marked. After an extensive discussion of incision placement based on patient preference,
brow pattern, hair density, and forehead width, an elliptical incision
is demarcated that is 4 to 5 cm in length and 2 to 2.5 cm in width
T
The closer the incision is to the eyebrow and less ptotic the brow,
the wider is the planned excision
F The closer the incision is to the eyebrow and less ptotic the brow,
the narrower is the planned excision
the more ptotic the
brow or farther away the incision is from the eyebrow, the wider the
excision
T
The lateral temporal subcutaneous brow lift has evolved to become
the authors’ technique of choice for managing the aging lateral brow
T
The incision from the
lateral temporal lift heals quite well, and the resulting scars are often
nearly imperceptible.
T
Complication of direct temporal brow lift
relapse
scar revision
Late fluid collection
Skin ischemia and necrosis
A Spock-like
appearance results from unbalanced disruption of medial brow
elevators
t
The
temporal branch of the facial nerve does not have an intramuscular course in the field ofa brow lift
T
The supratrochlear nerve does not have a motor component
T
