Solving the Endoscopic Forehead Conundrum: Go Deep to the Deep Temporal Fascia

SUMMARY: This article introduces an alternative approach to the endoscopic forehead technique that avoids critical anatomical structures encountered in the standard subtemporoparietal fascial plane and allows unfettered access to the orbital ligament. The technique approaches the orbital ligament deep to the deep temporal fascia lateral to the temporal line of fusion. The temporal line of fusion is broken from a lateral to medial direction to communicate with the previously dissected subpericranial plane in the central forehead area. Fasciotomy of the orbital ligament is performed in a lateral to medial direction, the length of which is determined by the patient's unique aesthetic goals. Results show high patient satisfaction, minimal morbidity, and an average eyebrow elevation of 2.64 mm at 10.9 months after surgery. There were no instances of frontal nerve weakness.