BOSTON (October 3, 1998) -- Plastic surgeons now have a number of techniques available for rejuvenation of the forehead or eyebrow area, allowing them to choose the best treatment for each specific patient, according to a study to be presented at the 67^th Annual Scientific Meeting of the American Society of Plastic Surgeons (ASPS), October 3-7 in Boston.

"With so many different surgical and non-surgical techniques for rejuvenation of the face," said Alan Matarasso, MD, in private practice in Manhattan and clinical associate professor of plastic surgery, Albert Einstein College of Medicine, New York City, "we can tailor the treatment to meet each patient's specific needs."

The study included a consecutive series of 100 patients who requested plastic surgery for the following indications: horizontal forehead creases, vertical wrinkles between the eyebrows, droopy eyelids, and hooded eyebrows too low above the eyes.

Results of the study showed that no one technique was predominant, but that each had benefits for certain patients depending on individual variations in anatomy. In addition, the choice of technique for forehead surgery was more balanced between "open" and "closed," than in recent years when endoscopy ("closed") was the predominant treatment.

Among the cases studied, 35 percent of patients had an "open" surgical procedure, either a coronal or anterior incision. In the coronal technique the incision begins at ear level on one side, runs in the scalp and continues to the other side. The coronal incision is usually made well behind the hairline so that the scar won't be visible. In cases where the patient has a high hairline, the anterior incision near the hairline may be used to reduce the forehead height so that patients appear to have a lower hairline after surgery.

A smaller group, 33 percent, had endoscopy, a "closed" surgical procedure. The typical endoscopic forehead lift requires only three to five short incisions, each less than one inch long, for insertion of the endoscope probe. Because the incisions are shorter, there may be reduced risk of sensory loss and the patient may recover more quickly. The endoscope contains a pencil-like camera device connected to a television monitor, which allows the surgeon to have a clear view beneath the skin. Another instrument inserted through a different incision is used to weaken muscles and underlying tissues to produce a smoother appearance.

The third group, 32 percent, had "limited" procedures, including excision of the corrugator muscle between the eyebrows from the same incision used for their eyelid surgery and injections of botulinum exotoxin Type A (BTX-A). These treatments smoothed the troublesome vertical lines which appear, often at a young age, between the eyebrows. BTX-A is a neuromuscular blocking agent that temporarily freezes the muscles to reduce frown lines, horizontal forehead lines, crow's feet or horizontal bands on the neck. The surgeon makes several injections into the appropriate muscles with a tiny needle. The toxin begins to wear off after three to four months, and the patient may choose to repeat the procedure at that time to maintain the improved appearance.

The American Society of Plastic Surgeons represents 97 percent of all physicians certified by the American Board of Plastic Surgery (ABPS). By choosing an ASPS member plastic surgeon who is certified by the ABPS, patients can be assured that the physician has graduated from an accredited medical school and completed at least five years of additional residency, usually three years in general surgery and two years of plastic surgery. To be certified by the ABPS, a physician must also practice plastic surgery for two years and pass comprehensive written and oral examinations.