To measure functional and emotional health status, the Acute Short Form 12v2 (SF-12) was administered, including 8 scales resulting in 2 summary measures: Physical Health (PCS) and Mental Health (MCS). The study protocol included 4 approximately 10-minute postoperative telephone calls on postoperative days (POD) 1, 3, 7, and 30. The PI was trained in data-collection procedures and has experience working with the EFS patient population. The PI conducted all interviews and recorded responses on paper survey forms (not anonymized). Following review of the study protocol, eligibility, and oral consent, basic demographic information and preoperative baseline health and pain measures were collected during the first telephone call. Verbal informed consent was provided by which the patients agreed to the use and analysis of their data the UCLA IRB provided a waiver of written consent on the basis that the research presented no more than minimal risk of harm to subjects and involved no procedures for which written consent is normally required outside of the research context (as per the Department of Health and Human Services Part 46 Protection of Human Subjects, Subpart A, section 46.117 (1)(ii)). Once completed, study flyers were returned by fax (with prospective subject’s name and telephone number) to the principal investigator (PI), and potential subjects were contacted by phone. To recruit patients, designated office personnel offered each potential subject a study flyer. The study was approved by the University of California Los Angeles (UCLA) IRB. Enrolled subjects met the inclusion criteria of being: (1) female (2) 34–80 years old (3) able to read, write, and understand English and (4) with telephone access. Data collection and analysis took place between Augand July 20, 2014. 24 Participants were recruited from 12 private cosmetic practices in 3 counties in southern California. The target population was women aged 34 to 75 years undergoing EFS, which is representative of the 91% of EFS patients. This observational study used a single-group, prospective, repeated-measures longitudinal design. We predicted that pain would be present immediately postsurgery and decrease in intensity within 1 week of EFS, and that it would share characteristics with migraine headache. Given anecdotal reports of pain lasting over a week postsurgery, we assessed pain up to 1 month after EFS. The purpose of this study was to systematically describe the characteristics, including intensity and quality, and analgesic responsiveness, of pain following EFS. 21-23 Because migraine is believed to be at least in part mediated by trigeminal inputs, it was theorized that trigeminal injury due to the EFS procedure would share symptoms with migraine. Trigeminal activation and neurological dysfunction involving both peripheral and central sensitization are believed to play a role in migraine. The characteristics of postoperative EFS pain may have similarities with migraine symptoms, which could inform treatment options. 17 Postoperative reports of nerve apraxia and neuropathic pain are consistent with trigeminal nerve trauma occurring during surgical dissection. Patel speculated that a potential cause of pain following EFS was trigeminal nerve manipulation or injury during surgical dissection, resulting in trigeminally mediated pain. Previous studies that do report headache following EFS include case series written by surgeons, 12, 15, 19 which suggest moderate to severe postoperative headache pain following EFS. The majority of published research on EFS focuses on anatomic dissection, surgical techniques, and aesthetic outcomes, 11-18 with little emphasis on postoperative pain. 5, 7-10 However, despite the lower invasiveness, pain remains a common postoperative experience. The EFS technique minimizes lengthy scars and alopecia and produces overall aesthetic outcomes equal to those achieved with the traditional coronal incision approach. 6 The EFS technique for foreheadplasty surgery, introduced in 1991 as a less invasive procedure than the traditional coronal browlift, is believed to have contributed to the sharp increase in forehead lift surgeries from 14,000 in 1991 to over 120,000 in 2000. 3-5 EFS may also be performed to correct physical genetic defects, and abnormalities from disease or trauma. The surgery is minimally invasive, and aims to eliminate or ease signs of aging in the upper one-third of the face by correcting eyebrow ptosis, and reducing glabella and forehead wrinkles. Endoscopic foreheadplasty surgery (EFS), also known as endoscopic forehead lift or endoscopic browlift, is a procedure commonly performed on women (91.7%), 1, 2 but there are few data on the presence or treatment of postsurgical pain.
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