Endoscopic forehead rejuvenation: II. Long-term results

Background: The purpose of this study was to analyze the long-term objective and subjective outcomes in patients who have undergone endoscopic forehead rejuvenation. Methods: Preoperative and postoperative photographs of 100 patients who underwent endoscopic forehead rejuvenation by one surgeon (B.G.) between 1993 and 2001 were objectively analyzed. Postoperative changes in left and right eyebrow position were assessed in each patient by counting the number of pixels in the digitalized photographs and by clinical measurements, and compared with preoperative values. In addition, subjective ratings of the surgical outcome obtained from both the patient and the evaluating surgeon were compared. All data were analyzed using the paired t test. Results: The average postoperative follow-up was 44 months (range, 12 to 95 months). Statistically significant differences in brow position between the preoperative and postoperative periods were observed in the following categories: the average distance from the lower brow margin to the upper eyelid margin (p < 0.005), the average distance from the lateral brow margin to the medial canthus horizontal line (p < 0.001), elevation of the lateral canthus relative to the medial canthus (p < 0.001), and the distance between the medial margins of the eyebrows (p < 0.001). In addition, preoperatively, 74 percent of eyebrows were positioned below the superior orbital rim, whereas 97 percent were positioned at the rim or above postoperatively, with 82 percent positioned above the rim. The most common complications were some degree of persistent paresthesia (50 percent), itching (14 percent), and forehead dynamic imperfections and irregularity (10 percent). Conclusion: Endoscopic forehead rejuvenation improves brow position relative to the orbital Hill, brow arch form, vertical frown lines, and horizontal frown lines of the forehead, with stable results many years after surgery.