Brow and forehead lift with cranial suspension

Background: Unsightly scars after facial surgery might be a worry for patients and surgeons alike. To prevent unfavorable scars after facial operations, it is inevitable for the surgeon to adhere to different principles and to follow an algorithm: patient assessment, incision planning, surgical technique, suture material, and postoperative scar management. A defined knowledge about the pathophysiology of wound healing is required. The aim of this report is to serve as a teaching purpose and to verify the well-known empirical practices in scar prevention with the corresponding explanatory research. Based on these findings, the suggestion of an appropriate algorithm for the best scar management will be elaborated. Methods: This article elucidates the basics of unsightly scar prevention and the concomitant scientific proofs in detail by reviewing the literature and newest research published in PubMed. Results: The preoperative, intraoperative, and postoperative guidelines for the achievement of acceptable facial scars will be distinguished regarding the valid state of knowledge. Special attention is drawn to the “flat incision technique” as the first surgical step. Based on the newest research, an algorithm of the important preoperative, intraoperative, and postoperative features to achieve scar improvement is presented. Conclusions: To prevent unsightly facial scars, a well-defined algorithm must be followed. In summary, three well-established, empirically proven measures are documented now by the equivalent physiological scientific proof: (1) the flat incision technique, (2) the wound closure with maximal tension reduction, and (3) the postoperative scar management with further tension reduction and more moisturizing of the scar.

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“…In this consensus, the importance of a tension-reduced wound closure cannot be overestimated. 4,7,29–34…”

Section: Discussionmentioning

confidence: 99%

“…In this consensus, the importance of a tension-reduced wound closure cannot be overestimated. 4,7,[29][30][31][32][33][34] A meticulous adaption of the wound edges is also very important for the achievement of a pleasant scar. Every irregularity along the epidermal layers should be avoided.…”

Section: Wound Closurementioning

confidence: 99%

An Algorithm for Prevention of Unsightly Facial Scars Considering the Newest Research Insights

Feinendegen

Grubnik

Feinendegen³

2022

Plastic and Reconstructive Surgery - Global Open

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“…Periosteal suspension is a proven method to achieve tension-free closure in the brow, as in other cosmetic procedures. [22][23][24][25] Besides better scarring, periosteal suspension of the orbicularis muscle is one of the proven methods to prolong the effect of direct browlift.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Direct Brow Lift With Suspension Technique

Fakih-Gomez¹,

Zarate²,

Rodriguez-Chaker³

et al. 2022

Am J Cosmet Surg

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Brow ptosis is one of the earliest signs of periorbital aging. To surgically correct the aging brow, several brow lift procedures have been documented with varying amounts of success. Direct brow lift is regaining its popularity as it is a simple direct surgery that allows the surgeon a precise positioning, elevation, and shaping of the brow. However, unaesthetic scarring is a potential handicap of this technique. To reduce scarring, many methods have been proposed from different design markings, beveling the incision, and tissue suspension. The versatility of direct brow lift lies in its design, execution, tissue management, and reduction of tension in the scar. In this article, we present a refined modification of the classic direct brow lift technique. The procedure is based on anatomical landmarks with a versatile and reproducible design, a 20° beveled incision, and periosteal suspension of the orbicularis muscle. In our experience, the use of this technique has enabled us to attain long-term stable aesthetic results.

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“…In the past, forehead wrinkles were addressed with coronal [1,2] and endoscopically assisted forehead lift [3] procedures. Today, botulinum toxin and hyaluronic acid fillers are used for this purpose because they are more effective and result in less downtime.…”

Section: Introductionmentioning

confidence: 99%