Dec 12

Forehead Lifts 10 Years Later: Is Endoscopic as Good as Open?

Recently, the Archives of Facial Plastic Surgery reviewed the progress made and things learned regarding brow lifts by facial plastic surgeons over the last 10 years.

For many people reading this blog you may be wondering why do open forehead lift when endoscopic techniques are available?

For some people, when they hear about open browlift, they think back to their mom or grandmother who had the traditional coronal brow lift that spanned from ear to ear. And they fear the potentially longer scar and even hair loss they heard about. Luckily, we can now do a different lift called a trichophytic lift that allows us to elevate your brow without moving your hair line higher while making an incision that is completely hidden.

trichophytic browlift

Notice that a few weeks after trichophytic browlift, the incision line is inconspicuous in the hair line

Since the early ‘90s, numerous authors have reviewed their experiences with the endoscopic technique and have reported that the endoscopic technique allows surgical access through small incisions, resulting in quicker recovery times, less morbidity, greater patient acceptance of surgery, and satisfactory results. Unfortunately, some reports question the effectiveness of the endoscopic forehead rejuvenation and characterize it as being cumbersome and not as effective long term.

In our experience, most of the flaws associated with the endoscopic technique are the result of a surgeon’s inexperience. However, that is not to say that there are not potential downsides to the endoscopic technique which need to be addressed. The study points out, and we agree, that the main flaws with the endoscopic treatment include:

  1. inadequate arcus marginalis release- this is the lining overlying the bone just over the brow that has to be released to allow for permanent upward movement of the brow
  2. inadequate frontalis muscle weakening- this is what allows us to weaken the muscle so you do not need as much Botox after,
  3. lack of fixation, especially in the lateral eyebrow- in the endoscopic technique since no skin is removed, there are numerous ways surgeons attempt to “fix” the brow into the new elevated brow position
  4. thick skinned patients with deep frontal and glabellar wrinkles- generally we recommend these patients strongly consider open techniques because it is simply very difficult to get the heavy skin to stay in the new elevated position

So if you are considering a brow lift, it is imperative for you and your surgeon to evaluate and accomplish:

1. Do a thorough preoperative evaluation of the upper face- including discussion of asymmetries;

2. Wide release;

3. Complete periosteal release at the arcus marginalis;

4. Variable transection of the depressor musculature;

5. Maintenance of the integrity of the frontalis muscle;

6. and, in endoscopic cases, adequate fixation of the forehead tissues to the elevated position, especially in the lateral portion of the eyebrow.

The truth is there are still many unanswered questions when it comes to the endoscopic technique. The study points out that there is a dearth of meaningful blinded trials with long-term follow-up to evaluate the plane of dissection, method of fixation, and muscle manipulation in endoscopic browlift techniques.

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