Rhinoplasty and brow modification: a powerful combination.

BACKGROUND Plastic surgeons have long recognized the importance of performing chin augmentation concurrent with a rhinoplasty to achieve facial balance. However, few surgeons consider the benefits of combining a rhinoplasty with brow modification to achieve a better aesthetic result. By increasing the size of the middle third of the face, the nose will automatically appear smaller. OBJECTIVE The authors describe anatomical dissections that provided perspective on the facial anatomy of the areas being studied and report the results of concurrent browlift and rhinoplasty procedures in a retrospective series of patients. METHODS The present study consisted of 2 parts: anatomical dissections and a retrospective chart review. The nose and central forehead area were dissected in 7 fresh cadavers at the time of autopsy to understand the anatomical relationship between the various muscles in the radix/glabellar region and to assess the muscle resection occurring in the clinical procedures. We also reviewed the charts of 24 patients who underwent combined rhinoplasty and brow modification with the senior author (R.K.D.) during a 2-year period (July 2010 to June 2012). Younger patients underwent a central browlift (CBL) with screw fixation, while older patients (ages 34-60 years) underwent full 5-incision endoscopic forehead lifting. RESULTS The age range for patients in this series was 14 to 60 years. Two patients were men and 22 were women. There were 12 primary and 12 secondary procedures in the series; 13 patients underwent CBL and 11 had EFL. The mean follow-up was 18 months. One patient had a persistent fluid accumulation in the glabellar region, which required drainage. One patient requested additional refinement of her nasal tip. CONCLUSION Modification of the central brow can dramatically change the aesthetic polygons of the nose/glabellar region. A CBL with radix/glabellar muscle excision is important in younger patients who need a well-defined nasion and older secondary patients who feel that the upper third of their nose is still heavy. A full EBL can enhance the facial appearance of older patients in whom a rhinoplasty alone would have a modest impact.