سلام

امروز قصد دارم تا فصل ۶۷ از کتاب جراحی فک دهان و صورت پیترسون ۲۰۰۴ که هنوز در ایران ان را نداریم و قول داده شده که در نمایشگاه امسال کتاب به معرض دید عموم برسد را در اینجا بزارم براتون به صورت صفحه به صفحه

فصلی تحت عنوان

CHAPTER SIXTY-SEVEN

Forehead and Brow Procedures

Angelo Cuzalina, MD, DDS

Upper facial cosmetic surgery has enjoyed an

unprecedented increase in popularity over the

past decade. The yearning of baby boomers to

look and feel rejuvenated has led to new endoscopic

techniques aimed at creating a more

youthful and natural appearance with shorter

recovery periods than existed in past decades.1–3

The ultimate goal of improving a person’s

appearance remains unchanged. Society shapes

our views of what looks attractive, and no mathematic

formula can ever be used to determine an

ideal eyebrow position (Figure 67-1). Each individual

has his or her own unique perception of

facial beauty. For most people the upper face and

eyes impart more emotion than does any other

part of the human body; it is clear that rejuvenation

of this vital area can provide an esthetically

pleasing result.

Esthetic concerns of the forehead and brow

regions of the face affect a wide range of age

groups. Unlike the standard lower face and neck

rhytidectomy, which more commonly affects

patients after the age of 45 years, cosmetic concerns

in the upper third of the face may be evident

for patients in their twenties and thirties

owing to genetic predisposition. The forehead

and brow area must be entirely evaluated for a

wide range of interlacing diagnoses. Matching

the problem(s) to the ideal rejuvenation technique(

s) is essential for maximum esthetic benefits.

Thinning skin and laxity owing to age and

gravity encompass only a portion of the forehead

and brow dilemmas that must be addressed when

planning rejuvenation procedures (Figure 67-2).

The aging process typically leads to forehead

and brow ptosis on almost every patient; however,

it is important to distinguish whether the ptosis

in the forehead and brow region is owing to

problems with brow position, upper eyelid laxity,

or a combination of the two (Figure 67-3). Other

problems such as dynamic lines caused by muscle

activity in the glabellar region, variable hairline

patterns, bony abnormalities, and asymmetries,

as well as skin texture itself, also must be assessed

in relation to each other. Achieving the patient’s

desired expectation depends not only on sound

surgical skill and judgment, it also depends critically

on communication between the surgeon

and patient. Truthful disclosure of what can reasonably

be attained is prudent and helps to prevent

patient dissatisfaction.

Rejuvenation of the upper third of the face is

one of the most rewarding and fulfilling procedures

a surgeon can offer to select patients. Specific

elevation and correction of lateral hooding

can be appear natural and still impart a tremendous

improvement in the patient’s overall beauty

and youthful appearance (Figure 67-4). The goal

of this chapter is to review the upper third of

facial anatomy specific to forehead and brow

rejuvenation techniques and to discuss a variety

of the most common techniques for rejuvenating

the forehead and brow region.

Anatomic and Esthetic Considerations

It is generally accepted that a youthful forehead is

roughly one-third of the overall facial height.4–9

Essentially, the distance from the hairline to the

glabella is equal to the distance from the glabella

to the point at the base of the columella or subnasale

            (Figure 67-5). A youthful-appearing eyebrow

is different for men and women. The female

eyebrow should be arched with the highest point

of the brow on a sagittal line from the lateral canthus.

10,11 The entire brow itself should be above

the orbital rim. In general the medial brow of the

female is located ideally 1 to 3 mm above the

.