The two brow lifting methods I employ are the endoscopic approach and the tricophytic (open) approach. The method chosen depends on the hairline, because each method has a potential advantage and a potential disadvantage. I never use a coronal approach in cosmetic procedures, because it contains both disadvantages: a long incision and it lifts the hairline.
The majority of my patients prefer the endoscopic approach because it involves 4 small incisions. Small absorbable devices known as endotynes are placed in the outer table of the bone in order to lift the lateral brow area. The disadvantage of this procedure is that it will raise the hairline slightly, so it is less appropriate (and much more technically challenging) in patients with higher hairlines.
In patients with high hairlines, I utilize the tricophytic approach, which is performed via a curvilinear incision (at the hairline) which follows the ebb and tide of the hairline. The incision is executed with an extreme forward bevel, allowing for several rows of hair follicles to stay buried at the superior aspect of the incision. This allows for later growth of hair through the incision, thereby further concealing it. The advantage of this approach is that it offers greater control of the brow lift, and allows the surgeon to stabilize or even lower a high hairline. The disadvantage is that it is a relatively long incision. However,in the right hands, it is typically inconspicuous.
