Contour abnormalities can result if you don't have an eye toward the contour differences of the sexes. Men have a straighter contour to the eyebrow when compared to women, who typically have a central-lateral arch. In men, you can restore the ideal contour by removing a greater amount of tissue laterally. To avoid contour abnormalities, it's important to identify your goals and any potential problems preop. By noting the areas of the greatest brow ptosis, and recognizing the desired contour, you can minimize abnormalities.
Noticeable scars are inherent to the direct approach simply because of the incision location.
You can minimize them by choosing patients properly. The best candidates for the direct approach are older men with deep forehead wrinkles. Just as important, meticulous closure of the wound will minimize scars. Sensation problems occur due to injury or transection of the supraorbital and supratrochlear nerves or their branches. You can avoid significant sensation problems that result from injuring the large branches of the supratrochlear and supraorbital nerves by staying above the brow fat pad and frontalis muscle.