Midforehead incision: an approach to the frontal sinus and upper face.

The coronal incision has established itself as the principal surgical approach to the forehead. It allows for a well-hidden scar and a wide field of surgical exposure. The midforehead incision, described in the brow-lift literature, is a cosmetically acceptable alternative to the coronal incision for patients with forehead wrinkles or who are at risk for male pattern baldness. In an analysis of 33 consecutive open frontal sinus procedures, we compared patients who underwent i coronal approach to a midforehead approach for operative time, blood loss, length of hospital stay, and cosmetic result. There was a trend toward decreased operative time and decreased blood loss with the midforehead approach. The cosmetic result was acceptable in all patients. We advocate the use of a midforehead approach to the frontal sinus in patients with deep forehead creases and with hairline recession and elderly or infirmed patients who cannot tolerate prolonged procedures or significant blood loss.