Rejuvenation of the Aging Upper Third of the Face

Abstract

Age-related changes to the upper third of the face manifest, typically, as brow ptosis and the development of deep skin furrows. Depression of the brow evolves as gravity and the action of the corrugator supercilli, procerus, and orbicularis draw on the progressively inelastic forehead skin. Facial mimetic muscle action reveals itself over time via the development of deep forehead rhytids. Facial plastic surgeons have at their disposal several effective surgical, and recently, medical interventions to address these changes. Each technique has merits and suitable applications. This review examines the history of rejuvenation of the upper face, details the pertinent treatment modalities, and evaluates the context in which each is applicable.

Brow Ptosis Correction: A Comparison of Five Techniques

“…This study confirms prior work showing that procedures that elevate the brows from above are more effective than the internal brow techniques (p < 0.01). [8][9][10][11][12][13][14] However, IBR þ CDR achieved 75% of the overall elevation produced by EB. Although IBR þ CDR has the downside of temporary numbness in the territory of the supratrochlear nerve, many patients may be attracted by the comparable result with less expense and the conveniences of an office-based procedure.…”

“…1,2,5,17 The edges of the incision were undermined for $0.5 cm and closed in two layers with interrupted subcutaneous 4-0 chromic gut sutures and a running 6-0 ProlenEB was performed in a standard fashion, as previously described. 8,9,13,22,23 Three paracentral incisions and two temporal incisions were used. Dissection proceeded in the subperiosteal plane all the way to the superior orbital rim centrally and to the anterior limb of the lateral canthal tendon laterally.…”

“…Eyebrow ptosis is an important and frequent diagnosis in facial plastic surgery. [1][2][3][4][5][6][7][8][9][10][11][12] Gravity and aging work at least as much on the brows and forehead as they do on the eyelids. It is common for a patient to have dermatochalasis, eyelid ptosis, and brow ptosis simultaneously ( Fig.…”

Discovering the 21st Century Fountain of Youth: A Discussion of the Effectiveness of Popular Anti-Aging Therapies

“…Signs of aging in the upper third of the face include brow ptosis and the development of deep forehead skin furrows. Loss of skin elasticity combined with weakened muscle tone accentuates these changes [105]. Surgery aims to reduce forehead wrinkles and raise the brow to give a more youthful appearance.…”

Safety and Effectiveness of a Small Incision Lateral Eyebrow Ptosis Repair Technique Using a Frontalis Muscle Transposition Flap

“…The senescent changes producing eyebrow ptosis include incomplete interdigitation between the frontalis and the orbicularis muscles, 1 age-related elastolysis, loss of collagen, subcutaneous fat, and bone, [2][3][4] and gravitational descent of periocular skin, 5 musculature, 5 and fat pads. 6,7 Other mechanisms responsible for eyebrow position and contour include frontalis muscle tone and its balance against contraction of the eyebrow depressor muscles, 7 the paucity of eyebrow supporting structures laterally 6,7 , and unopposed depression by the orbicularis oculi laterally.…”