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12.09.2018 | Original Paper

Dermal subcision of Nemoto’s ligaments as a long-lasting treatment for forehead and glabellar wrinkles

European Journal of Plastic Surgery
Nader Gomaa Elmelegy, Ahmed M. Hegazy
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00238-018-1453-9) contains supplementary material, which is available to authorized users.



Ever since the beginning of recorded history, beauty has played a major social role. A youthful look, symmetry, and a soft, smooth skin texture, as well as an even colour, are the main characteristics and parameters of attractive and beautiful faces. The forehead is the first location in the face that shows wrinkles. Facial wrinkles show an increase in depth and severity with age in all faces, in both sexes, but usually, forehead wrinkles develop earlier in men than they do in women. The work published by Nemoto et al. in 2002 revolutionised the concepts about the aetiology and anatomy of forehead wrinkles, thus inspiring the authors to develop a new surgical technique for treatment.


Sixty-five patients participated in this study (50 females and 15 males). The age range in this series ranged from 26 to 59 years. Through stab incisions at the hairline level, a standard ENT myringotomy knife was used to cut the fibrous septae connecting between the superficial layer of the galea apponeurotica (that covers the frontalis and glabellar muscles) and the dermis.


The results showed a high level of satisfaction among both patients and an objective assessor with no negative comments. Patients rated the operative results excellent in 52.3% of this series, while the operative results were rated excellent in 47.7% of patients by an independent, objective assessment. Kappa analysis showed perfect agreement between the objective and subjective assessments (K = 0.839). The mean Lamperle classification was 3.1 before surgery and 0.7 3 years after surgery. There was a significant reduction in the mean Lamperle classification 3 years after surgery.


The cutting (dermal subcision) of fasciocutaneous ligaments of the forehead described by Nemoto et al. is a safe, economical and effective technique for forehead and glabella rejuvenation with long-lasting results.
Level of Evidence: Level IV, therapeutic study.

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