Downward descent of lateral brow (anterior hairline lifts, lateral subperiosteal lifts, temporal lifts, coronal brow lifts,
Botox)
Downward descent of central brow (anterior hairline brow lifts, coronal lifts, muscle resection techniques, Botox)
Hollowness of temporal fat pad (fat grafting)
Subcutaneous fat loss due to senile fat atrophy (no solution; fat grafting)
Vasodilation and exposure of small forehead veins (sclerotherapy or V-beam laser therapy)
Sun damage lesions (laser resurfacing, chemical peels, PhotoFacial treatments, N-Light laser, skin care, sun avoidance)
Epidermal and dermal atrophy (Retin-A, microdermabrasion)
Weakening of the periorbital septa with fat herniation (blepharoplasty)
Periorbital fat atrophy with subcutaneous volume loss (volume-sparing blepharoplasty with midfacial elevation;
orbital septal plication)
Globe hollowness and sinking due to periorbital fat atrophy (no treatment)
Superior orbital blepharochalasis (blepharoplasty, lateral brow lift, combination of blepharoplasty and lateral brow lift)
Inferior orbital blepharochalasis (blepharoplasty; midfacial rejuvenation procedures)
Nasojugal groove deepening (cheek lift procedures; autologous fat grafting, tear trough-type implants)
Midfacial complex ptosis (cheek lift techniques; arcus marginalis technique; facial volume augmentation)
Orbicularis oculi ptosis (suborbicularis cheek lift techniques; canthopexy)
Horizontal forehead rhytids (Botox, lateral brow lift techniques; coronal brow lifts)
Glabellar rhytids (Botox; muscle division-resection techniques; nerve ablation techniques; coronal lifts)
Perinasal rhytids (Botox, skin care, nasal augmentation)
Crow’s-feet (suborbicularis cheek lift techniques; temporal or lateral brow lift techniques; Botox)
Thinning and loss of hair at anterior hairline, temporal hairline, sideburn (hair transplantation; if iatrogenic, hairrestoring
flaps and modification of vectors in revisional face lift)
Lightening (graying) of anterior hairline, temporal hairline, sideburn (hair coloring)
Darkening of the corneal surface (no treatment)
Thinning and loss of eyelashes (no treatment)
Lateral canthal ligament ptosis (lateral canthopexy)
Ptosis or rupture of the levator mechanism of the upper eyelid (levator aponeurosis repair)
Nasolabial fold heaviness and folds (face lift, midface lift-cheek lift, autologous tissue transplantation to nasolabial
folds, temporary fillers)
Buccal fat pad atrophy (no treatment)
Malar fat pad atrophy (autologous tissue transplantation)
Lip atrophy (autologous tissue transplantation)
Upper lip lengthening (lip lifts; laser resurfacing)
Platysmal ptosis and banding (platysmaplasty with face and neck lift; platysmaplasty alone; Botox focally)
Facial skin and fat descent (face lift, neck lift, soft tissue augmentation)
TRENDS
The recent history of facial rejuvenation can be viewed as a series of trends toward avoidance of undesirable conspicuous effects of the rejuvenation process. Specific areas in which attention has been stressed are hairline preservation, avoidance of overresection, and periorbital fat preservation. Elevation of the midface with the lateral and lower face, customized brow lifting procedures, and use of fat and composite grafts to replace tissues lost to fat atrophy have enhanced results and avoid excessive incisions. It is now entirely possible to rejuvenate the brow by selectively reducing muscle activity in specific areas without lifting anything. Hence, the coronal brow lift as a sole option in rejuvenating the brow is superceded by several smaller and more targeted operations.
CHOICE OF BROW REJUVENATION TECHNIQUES
The decision whether to perform a coronal lift, an endoscopic lift, a minimally invasive direct brow lift,
a selective muscle resection, or the injection of Botox is complex and cannot be predetermined by mathematical algorithms. Rather, a careful discussion with patients elicits the troubling aspects of their appearance and their expectations.
RELEVANT ANATOMY
The deep temporal fascia is the covering in the temple of the temporalis muscle. Above it, containing the superficial temporal vessels, is the superficial temporal fascia. The intermediate temporal fascia and deep temporal fascia surround the temporal fat pad; the superficial temporal fascia, which continues below the zygoma as the superficial musculoaponeurotic system (SMAS), is superficial to the intermediate temporal fascia. The intermediate temporal fascia and the deep temporal fascia then insert onto the zygomatic periosteum from above. The tissue above the zygomatic periosteum contains the frontal branch of the facial nerve, which originates at the tragus of the ear and courses 1 cm lateral to the lateral brow into the