Endoscopic Brow Lift: Safer, Easier, and Better for Patients

What patient wouldn’t want three or four very small incisions that heal rapidly with little or no scarring and no residual numbness, compared with a foot-long slice at or under the hairline that takes longer to heal and sometimes leaves a puffed-up scar and/or permanent loss of sensation?

Most opt for the smaller incisions, according to Oscar M. Ramirez, MD, Clinical Assistant Professor, Department of Plastic Surgery, Johns Hopkins University and University of Maryland, both in Baltimore. The endoscopic forehead lift is a much safer operation than the open forehead lift. The risks of infection, scarring, numbness, and hair loss are significantly less compared with the open approach.

Procedural Technique

A brow lift (also called a forehead lift) is done on its own or as part of an upper and/or lower blepharoplasty or a more comprehensive facelift. Its purpose is to rejuvenate the forehead, erase horizontal or vertical wrinkles and frown lines, raise sagging skin, and give a more open look to the face. The skin looks refreshed and younger, especially when combined with eyebrow elevation.

Endoscopic brow lift was first described in 1980, and the technique showed a clear advantage over the classic coronal brow lift, especially in the area of the superior and lateral orbital rims.

Aging and the squinting that results from worsening vision causes muscle constriction around the eyes, said Ricardo L. Rodriguez, MD, Head, Plastic Surgery Division, Greater Baltimore (MD) Medical Center. The brow is thus pulled down and creates an illusion of excessive skin, when in reality there is none. You get the appearance of excess skin from excessive brow movement over time, which creates wrinkles. Sometimes just lifting the eyebrows is enough to solve the forehead problem, but that’s getting ahead of the story.

He described an endoscopic brow lift: The hair is tied back and secured with rubber bands, or it may be trimmed around the planned incisions. Under local anesthesia with a light intravenous sedative, three or four small incisions (about an inch each) are made in the scalp above the hairline, and a 4 mm diameter endoscope is inserted at a 30-degree angle into one incision. The scope has a xenon light source that is connected to a camera and in turn hooked up to a video monitor. The light and camera provide a clear view of muscles and other tissues beneath the skin. Various surgical instruments are inserted into the other incisions.