The procedure is indicated in the patient whose brows have fallen, beginning to overhang the eyes, whose forehead is wrinkled with transverse lines and vertical lines over the bridge of the nose.

It may be accomplished by “open” or “closed” (endoscopic) surgery. The open procedure, obviously the older, has the advantage of easier and direct vision, and if there is substantial excess skin this is the only choice. And endoscopic apparatus is not available to all surgeons in all parts of the world, and even where it is, there are surgeons who prefer to continue with the “tried and true” they have become used to doing.

The incision is “coronal,” that is, from above one ear, over the top of the skull and down to the other. It may be made at the hair line in a woman, or behind that line in a man whose hair is receding. The skin margins are elevated, and slightly distal to the incision the aponeurosis of Occipito-frontalis (called galea) is incised and elevated, it strips quite easily. The elevation is carried down to the orbital margins, freeing the attachment from the orbital margins, preserving the neuro-vascular bundles, dividing all or part of Corrugator and Procerus muscles.

The aponeurosis is then drawn up, correcting the downward drift, the Frontalis belly may be reduced in size if overlarge, and the galea is sutured in place; excess skin is trimmed away as desired. A firm dressing may be indicated.