The Brow and the Forehead
Do not excise the frontalis muscle. That could result in skin adhesion to the calvarium and an unnatural appearance of a frozen forehead without expression. In elevation of the forehead, the scar should be in W shape to avoid a visible track. Even sometimes it will be necessary to implant hair plugs to minimize that scar.
Do not remove the retro-orbicularis oculi fat under the brow since it could result in brow adhesion to the orbit and prevent its movement.
Do not fix the brow to the orbit by suturing it to the periosteum since it will immobilize it.
Do not excise the corrugator completely since it will eliminate the frown and its attendant lines; however, it will create a depression which is unsightly and difficult to correct.
Check the height of the brows before deciding to raise them. They are often higher than you think and any elevation will result in an exaggerated look (Fig. 65.7).
The shape of the brow is distorted when:
- An aggressive corrugator procerus removal (even with endoscopy only) is performed on a medial brow that is already positioned too high. The resulting "surprised look" is then difficult to correct.
- The medial part of the brow is elevated in addition to the lateral and central brow when it is detached from his periosteal attachment.
- The lateral brow can less often be too high except in cases where it is already highly positioned, otherwise a pleasant lateral elevation is not a problem.
- Fig. 65.7. Undermined skin should not be pulled in only one direction since it could give the "wind-tunnel" effect. Levels of elevation and tension have to be at different angles
- On patients who have a tall forehead, it is preferable to place a pretrichial incision. However, depending on the direction of hair growth and the patient's hair style, a straight scar can be visible and it should be avoided by making a "W" incision. Hair transplants on the scar help in attenuating scar visibility.
- Problems arising from that pretricheal scar include the fact that the continuation of this incision in the scalp might leave a thin, hairless zone, thus giving patients dissatisfaction because of the visibility of that hairless area.
Do not pull undermined skin in only one direction since it will end up giving a "wind-tunnel" appearance to the face. Levels of elevation and tension have to be at different angles up to 90° of divergence.
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Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.
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