A Novel Endoscopic Forehead Lift Technique for Patients with Upper Facial Wrinkles: Morphometric Evaluation and Patient-Reported Outcome using FACE-Q Scales

Chinese patients more frequently complain of forehead wrinkles than eyebrow and upper eyelid ptosis. Besides the commonly used brow-lifting technique, a novel technique to satisfy the demands of Chinese patients is needed. In this article, we introduce our novel endoscopic forehead lift procedure and analyze the morphometric evaluation and patient-reported outcomes. From January 2010 to January 2017, 171 Chinese patients underwent endoscopic forehead lift in which two parallel incisions were made on the frontalis muscle to relieve forehead wrinkles. Biopsy forceps were used to bite off the glabella muscles to relieve wrinkles between the eyebrows. Lifting devices were not used. Morphometric evaluations of eyebrow locations were performed, and the vertical distance of the upper eyebrows was measured post- and preoperatively to evaluate the elevation range. FACE-Q scales were sent to patients who were still being followed-up. A total of 46 patients underwent the morphometric evaluation, which suggested that the eyebrows were elevated effectively. At 12 to 36 months postoperatively, the median post-/preoperative ratio was 118.4, 112.5, and 111.8% in the medial, middle, and lateral eyebrows, respectively. In the same patients, at 37 to 84 months postoperatively, the median post-/preoperative ratio was 116.6, 112.2, and 108.9% in the medial, middle, and lateral eyebrows, respectively. Sixty-five patients completed the FACE-Q scales, demonstrating high satisfaction levels with the forehead and eyebrow, outcome, and decisions, with a median score of 100 for each. Postoperative appraisal revealed that the lines in the forehead and between the eyebrows had a good outcome with scores of 86 and 93, respectively. The median number of years younger that patients thought they appeared was 7. The most frequent self-claimed recovery symptom was temporary forehead skin numbness (83.1%) followed by a receding hairline (46.2%). Our endoscopic forehead lift procedure was effective in relieving forehead and glabella wrinkles and lifting the eyebrows. This was a level of evidence III study.