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

With a coronal lift, a small minority of patients (2%) suffer from postoperative alopecia (which, for unknown reasons, does not always occur along the incision line) that resolves in a few months. When the hair grows back, it may be thinner. When this procedure was first done, patients had considerable facial edema, but that has been mostly eliminated by speeding up the dissection. This does not happen with the endoscopic procedure.

A coronal lift produces much more postoperative pain, and there is usually more numbness at the incision than with the endoscopic procedure. The numbness is soon replaced by itching, which most people think is far worse, that can last up to six months.

With both procedures, vigorous physical activity (exercising, heavy housework, and sex, for example-anything that elevates blood pressure) should be restricted for several weeks.

Dr. Rodriguez does only endoscopic procedures and said that the percentage in comparison to the coronal procedure is increasing-about 50% overall compared with 20% five or six years ago. Dr. Aly, on the other hand, does only coronal procedures, although this is because the hospital where he practices refuses to purchase an endoscope. I used to do them at my previous hospital, and this one will probably buy one soon so I’ll be back to doing them. About 75 percent of my colleagues do the endoscopic lift if they or the hospital have the equipment.

He encourages patients to have the coronal procedure because he is able to get more lift. But he says that if a patient insists on the endoscope, he refers them elsewhere.

In terms of cost, there is little difference between the two procedures, but price varies significantly with geographical area. For instance, Dr. Rodriguez in Baltimore charges about $4000 for each endoscopic procedure, which includes use of the operating and recovery rooms, as well as most incidental hospital expenses. A few thousand miles away in Iowa City, Dr. Aly charges about $6000 for a coronal procedure, and that’s for his fee only. Hospital charges are extra.

Who Should and Shouldn’t Be Lifted

The best candidates for a brow lift are between 40 and 65 years of age, although some people in their 30s look much older than their years and can benefit from the procedure. Also, some people have inherited conditions, such as a very low or heavy brow (the Neanderthal brow) or deeply furrowed lines. Patients need good skin tone, and if they have ptosis of the eyebrows it should be in a very early stage. Sagging cheeks with deepening of the nasolabial crease and ptosis of the corners of the mouth are indications that a brow lift might not be as successful as anticipated. Patients should be in good health and preferably nonsmokers.