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Endoscopic Correction of Frontal Bossing

Background: Frontal bossing is a displeasing prominence of the supraorbital area. Aesthetic correction has been described as an open surgical technique. This report introduces an endoscopic approach to correction. Methods: A retrospective review was performed on all patients who underwent endoscopic repair of frontal bossing from 2002 to 2009. Demographics, intraoperative and postoperative course, and outcome variables were collected. Standardized preoperative and postoperative photographs were used for analysis. Aesthetic improvement of the forehead was assessed with a four-point scale (1 = no improvement at all, 4 = significant improvement) by six randomly selected observers. Preoperative facial imaging (lateral skull radiography or computed tomography) was obtained on all patients to assess the thickness of the anterior wall of the frontal sinus. Results: Ten patients met the study inclusion criteria. Overall, the observers assessed the degree of frontal bossing correction as moderate improvement (2.67 on a four-point scale survey). All endoscopic frontal bossing corrections were performed on an outpatient basis by the senior author (B.G.). No patient was admitted to the hospital for postoperative complications. No complications (such as alopecia, hematoma, contour deformities, or penetration into the frontal sinus) were seen. The limiting factor in achieving optimal outcomes was inadequate thickness of the anterior wall of the frontal sinus. All patients had various concurrent facial rejuvenation procedures. Conclusions: Endoscopic correction of frontal bossing is an effective and safe surgical technique in forehead aesthetics. This technique is ideal for patients with a mild frontal bossing deformity who have an adequately thick anterior frontal sinus wall. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.