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At least 91 records · Page 5Linked to original sources
PubMed1995

Esthetic refinements in forehead flap nasal reconstruction.

OBJECTIVE: To identify refinements in forehead flap nasal reconstruction that consistently provide better esthetic and functional results. DESIGN: Case series of patients undergoing forehead flap nasal reconstruction from July 1, 1987, to May 31, 1994. SETTING: University hospital ambulatory surgery department. PATIENTS: Thirty-two patients with various nasal defects. INTERVENTIONS: Modifications of currently accepted techniques of paramedian forehead flap nasal reconstruction, namely, flap harvest and contouring, W-plasty closure of the superior forehead donor site, and creation of soft-tissue triangles. The principles of open-structure rhinoplasty are incorporated into cartilaginous reconstruction of the nasal tip and columella. The alar rim is reconstructed with cartilage grafts placed at the nasal rim. MAIN OUTCOME MEASURES: Esthetic and functional results of nasal reconstruction were subjectively graded by three otolaryngologists (V.C.Q., D.A.S., and M.F.R.) and the patients. RESULTS: Improved esthetic and functional nasal reconstruction. The most common nasal subunits reconstructed were as follows: ala, 27 patients (84%); side-wall, 22 patients (69%); dorsum, 18 patients (56%), and tip, 15 patients (47%). The esthetic results ranged from average to excellent (3 to 5 on a scale of 5), the functional results ranged from improved to much improved over preoperative breathing (4 to 5). Two patients required unplanned surgical revisions. Forty-seven percent of patients chose to undergo dermabrasion. Five patients required postoperative intradermal injection of triamcinolone acetonide (Kenalog). Three patients required preoperative tissue expansion. Flap or graft loss, infection, or hematoma did not occur. CONCLUSIONS: The predictability of the techniques in providing excellent results in patients undergoing nasal reconstruction decreases the need for revision procedures and helps the patient and the surgeon achieve the desired outcome.

Aged↗
PubMed2004

Unusual forehead tremor in a patient with essential tremor.

Voice and head (neck) tremor commonly occur in patients with essential tremor (ET), but involvement of cranial musculature is generally limited to these specific cranial structures, and action tremor of the forehead has not been reported. We describe a patient with ET who had forehead tremor. The tremor seemed to be task-specific, and neurophysiological features suggested that the forehead tremor was dystonic. The presence of forehead tremor in a patient with ET probably indicates an additional pathophysiologic process. The explanation for the specificity of involvement of cranial musculature in ET is not known, but this clinical observation might help guide investigators who are interested in the underlying pathophysiology of this condition.

Electromyography↗
PubMedDate not supplied

Neurosensory preservation in endoscopic forehead plasty.

The recent introduction of endoscopic techniques and instrumentation in aesthetic surgery was caused in part by the desire to minimize surgical scars as well as to decrease the possibility of sensory changes secondary to extended incisions, such as the execution of a coronal incision in performing a forehead plasty. Although endoscopic surgical techniques provide field magnification together with excellent illumination, localization and preservation of the forehead neurovascular bundles via the endoscope can be time consuming and tedious. A new method is introduced where percutaneous localization of the supraorbital and supratrochlear nerves enables the surgeon to perform an endoscopic forehead plasty in an expeditious manner with preservation of sensation of the forehead and scalp.

Endoscopy↗
PubMed1992

Do forehead lifts lift or unfurl?

Forehead lifts are becoming increasingly more popular as an adjunct to facial rejuvenation. Considerable confusion exists as to how much the eyebrow should be elevated and how much scalp should be removed to achieve this goal. In an effort to evaluate this question, we have reviewed our recent forehead lift experience. These were done with forehead flap dissection down to glabella and supraorbital ridge, partial resection of corrugator supercilii, procerus, and frontalis muscles, and limited skin resection. We suggest that a natural-appearing, rejuvenating forehead lift should unfurl facial wrinkles without excessive eyebrow elevation. Technical maneuvers to obtain this goal are discussed.

Forehead↗
PubMed1993

Aesthetic incision in the subcutaneous forehead lift.

The forehead plays a relevant role, perhaps the most important role, in what we shall call the topographical area of the orbital rims, since it flaccidity causes the eyebrows to droop, thus dragging down the upper eyelid and producing skin redundancy. Most published works on the subject of the forehead lift describe the classic coronal incision, with subgalea dissection involving an individualized design for each patient, according to the density of the hair. However, when the forehead has hair growing high on the head, the coronal incision becomes an anterior incision, following the first hairline. However, this has the same problems as the coronal incision, namely, anesthetizing the posterior part of the scar and, in some cases, depression of the scar on the edge of the flap caused by the retraction of the galea and the inadequate elimination of forehead furrows. Over the past two years, the author has used a nonlinear anterior incision with subcutaneous dissection in many select cases.

Forehead↗
PubMed1991

Criteria for the forehead lift.

We have developed clinically useful measurements to assist the surgeon in deciding when to do the forehead lift and where to place the incision. Also, we have reviewed our experience over the past decade and discuss the four categories and applications of forehead lifts. We use three indications for forehead lift: ptosis, creases, and previous facelift (PCP). There are four basic surgical techniques applicable to the upper face: (1) direct browlift, (2) midforehead crease incision, (3) prehairline incision, and (4) posthairline incision. We determined more accurate guidelines from measurements taken on 50 volunteers, as well as patients seeking a facelift. The line of measurement in a vertical plane extends from the midpupil to the top of the eyebrow and up to the hairline. We have found that the normal distance from the midpupil to the upper edge of the eyebrow on average is 2.5 cm and that the distance from the upper edge of the eyebrow to the hairline is approximately 5 cm on average. If the distance from pupil to brow is less than 2.5 cm, then the patient may benefit from a forehead lift. If the distance from brow to hairline is less than 5 cm, then we use a posthairline incision in females. If this same distance is greater than 5 cm in females, we advise the prehairline incision. In male patients we strongly consider direct crease incision. The direct browlift is reserved for minimal ptosis, asymmetry, or patients who wish a minimal procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

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.

Dermatologic Surgical Procedures↗
PubMed2005

[Indication, technique and clinical out come of the endoscopic assisted forehead and brow lift].

AIMS: The aim of this study was to determine the indication for endoscopic-assisted forehead and brow lift and to present the surgical technique and evaluate clinical outcome. PATIENTS AND METHODS: A total of 61 female patients between 36 and 64 years (s=49.64) were operated from 1999 through 2002 with the endoscopic-assisted forehead and brow lift and were observed pre- and postoperatively and 6 months after surgery. The galea aponeurotic flap was fixed through a bone tunnel (tabula externa) with nonabsorbable sutures in all patients. We measured the distance between the middle of the pupil and the most cranial point of the eyebrow as well as the largest distance between the eyebrow and the hairline intraoperatively and 6 months after surgery. The patients' satisfaction with the outcome of these surgical procedures was determined on a scale from 1 to 10 with 1 as the worst and 10 as the best mark. RESULTS: We found a brow lift of 8.03 mm (s=1.622) on average. The endoscopic forehead and brow lift was indicated up to the maximal distance of 12 cm between the eyebrow and the hairline. The patients' satisfaction with the outcome was registered on average at 6.98 (s=1.36) on our scale. A temporary unilateral weakness of the frontal branch of the facial nerve was the severest complication found postoperatively. CONCLUSION: The endoscopic-assisted forehead and brow lift is a safe and effective method to improve upper face aesthetics. A high grade of patient satisfaction is obtainable. The advantage in using this method is the invisible scar formation. The indication is limited by a high hairline.

Adult↗
PubMed1991

Inadequacy of the forehead reference montage for detecting abnormalities of the spinal N13 SEP in cervical cord lesions.

Cervical somatosensory evoked potentials (SEPs) recorded using forehead and anterior cervical reference montages were compared in 6 patients whose MRI showed a cervical syrinx. All patients presented with a segmental loss of pain and temperature sensation in upper limbs, but no clinical evidence of dorsal column system dysfunction. Cervical SEPs recorded using the forehead reference montage were normal in all cases, while the N13 potential recorded using an anterior cervical reference was reduced, or absent, in 11 median nerve SEPs out of 12. This discrepancy results from persisting scalp P13-P14 far-field potentials, which were picked up by the forehead, but not by the anterior cervical, reference. It is concluded that the forehead reference montage is inadequate for assessing selectively the spinal N13 potential and should be abandoned for cervical SEP recording.

Adult↗
PubMed2004

Management of forehead and brow deformities.

The subcutaneous trichophytic forehead browlift allows rejuvenation of the forehead with precise, stable brow positioning, excellent visualization, and direct treatment of the brow and forehead musculature. This method avoids lengthening the forehead and, with meticulous closure, can produce an imperceptible scar and natural-appearing hairline.

Endoscopy↗
PubMed2005

Endoscopic forehead lifting.

The aging process of the face is often most drastic in the upper third of the face, with the development of forehead rhytides and brow prolapse. Traditionally, an open approach to addressing aging of the forehead has been used. The introduction of endoscopic technology to surgical correction of forehead aging has resulted in comparable results without the significant disadvantages inherent in the open approach. The success of the endoscopic technique for forehead lifting has been reflected by its immense popularity and demand by the public. The aging process, relevant surgical anatomy, patient selection and planning, surgical technique, and current controversies in fixation are reviewed.

Endoscopy↗
PubMed2005

Flow motion pattern differences in the forehead and forearm skin: Age-dependent alterations are not specific for Alzheimer's disease.

Oscillations in laser Doppler signals derived from the forehead and forearm skin were analyzed in 77 healthy probands from 4 various age groups (ranging between 15 and 77 years) and 22 late-onset sporadic Alzheimer's disease (AD) patients. A characteristic pattern of oscillations in the microcirculatory blood flux ( approximately 8 cycles/min, 0.13 Hz) was observed in the forehead skin, the occurrence of which correlated inversely with age (r = 0.80). The occurrence of forehead vasomotion pattern was 100% in the teenagers, whereas it was significantly less in the elderly control subjects (32%) and in the AD patients (18%). Forearm reactive hyperemia was provoked by 1-min occlusion of the brachial artery, and the vascular reactivity was calculated. This phenomenon also proved to be age-dependent, but the process was not related to AD. Our results indicate that the lack of forehead vasomotion reflects aging better than does the forearm vasomotion. Both of these functions are preserved in AD.

Adolescent↗
PubMed1996

Endoscopic forehead lift: technique and case presentations.

PURPOSE: The advent of the endoscopic forehead lift has provided an alternative to the conventional open approach. This article describes the basic technique, with some modifications, and reports three clinical cases. RESULTS: The subperiosteal forehead technique rejuvenates the upper third of the face with no scalp resection, minimal risks of hypesthesia, limited risk of alopecia, reduced tissue trauma, small camouflaged scars, less bleeding and edema, improved postoperative comfort and faster recovery compared with the standard open techniques. CONCLUSIONS: The endoscopic subperiosteal forehead lift is a useful technique for providing rejuvenation of the upper third of the face. It reduces or eliminates forehead rhytids by eliminating the reflex contracture of the frontalis and contributes to softening of the vertical glabellar rhytids. Longitudinal studies will be required to assess the effectiveness of this technique compared with open techniques.

Adult↗
PubMed1999

Unilateral transient forehead paralysis following injury to the temporal branch of the facial nerve.

BACKGROUND: Cutaneous surgery in the temporal region of the forehead can lead to injury to the superficial temporal branch of the facial nerve. A flattened forehead and with ipsilateral forehead paralysis can occur with damage to this nerve. METHODS: A case is presented of transient forehead paralysis resulting from Mohs' micrographic surgery with reconstruction of the defect. The paralysis resolved over a period of fifteen months. RESULTS: The anatomy of the nerve makes it susceptible to injury during cutaneous surgery. The area of danger is the area superior to the zygomatic arch and lateral to the lateral eyebrow where the nerve is closest to the skin. CONCLUSIONS: Restoration of motor function usually occurs without intervention, but may take several months. Should motor function not recur, nerve grafting of a repair of the ptotic brow may be needed. The anatomy of the nerve is reviewed and brow lifting options are discussed.

Aged↗
PubMed2000

Successful correction of depressed scars of the forehead secondary to trauma and morphea en coup de sabre by en bloc autologous dermal fat graft.

BACKGROUND: Atrophic scars of the forehead can result from various pathologic processes including morphea en coup de sabre as well as trauma. A variety of surgical techniques can be used to correct these atrophic scars. OBJECTIVE: Soft tissue augmentation for correction of atrophic scars of the forehead using en bloc autologous dermal fat graft. METHODS: Use of en bloc autologous dermal fat graft harvested from the hip and inserted into a pocket created under the atrophic scar in two patients with depressed scars of the forehead. RESULTS: Overcorrection of the scars with en bloc autologous dermal fat grafts resulted in the treated areas becoming level with the adjacent skin within 3 months. Follow-up for a period of 12 months showed a perfectly level and stable graft with no further resorption. CONCLUSION: En bloc autologous dermal fat grafting appears to be a safe technique that provides excellent cosmetic results for the correction of small to medium depressed scars of the forehead.

Adipose Tissue↗
PubMed2001

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.

Endoscopy↗
PubMed2006

Excision of forehead osteomas: experience with 12 patients with use of an endoscopic technique.

Endoscopic excision of benign forehead masses has been previously reported on. A variety of pathology occurs on the forehead, and small-sized frontal bone osteoma is definitely a candidate for endoscopic surgery. The purpose of this study is to present our clinical experience with 12 consecutive forehead osteomas that were excised with the aid of an endoscope. With refinements in technique, the area of subperiosteal dissection was kept to a minimum; superficial ostectomy followed by smoothening of the frontal bone surface was efficiently performed. The patients' ages ranged from 20 to 67 years, and the diameter of the lesions varied from 0.8 to 2.2 (mean 1.1) cm. The mean operative time was 15 minutes, and there was no complication that required any other treatment. All the patients were satisfied with the final result. The authors have found that excision of forehead osteoma using an endoscope coupled with proper instruments to be very safe and effective with minimal morbidity.

Adult↗
PubMed1988

Nasal reconstruction with the expanded forehead flap.

This report details the experience with nine patients over a 3-year period who had partial or total nasal reconstruction using an expanded forehead flap. The history of nasal reconstruction is reviewed, emphasizing the evolution of the forehead flap as the ideal donor site. The author's experience with skin expansion of the forehead to produce a thin ideal flap is presented in detail. Complications of the procedure are reviewed. Technical considerations to achieve a good result are emphasized. The forehead donor site is minimal and well accepted. This procedure provides a solution to a major problem with partial and total nasal reconstruction.

Adult↗