I have consulted with several plastic surgeons regarding a brow lift. All recommend an endoscopic approach except one, who recommended a full coronal brow lift. He claims the endoscopic brow lift does not hold up in the long run due to failure of the fixation devices. Is this true? Any comments or recommendations would be appreciated. Thank you.
Does Endoscopic Brow Lift Last As Long As Full Coronal Brow Lift?
Doctor Answers 22
Endoscopic vs hairline vs coronal browlifts
How long an endoscopic browlift lasts depends on how the operation is performed. Endoscopic just means the doctor uses tubes to do the procedure, nothing more. If all the brow attachments are released and fixation is solid, the endoscopic browlift should have great longevity. If the frown muscles are "roughed up a little bit", longevity could be minimal. The more aggressive the endoscopic browlift, the more the hairline will rise (i.e. the forehead will rise). Where the brow is lifted is very much an artform, so no two doctors perform the procedure alike. Areas of baldness around the (usually 3) incisions are common.
Coronal lifts involve an ear to ear incision. The deep branch of the supraorbital nerve is always cut, so nerve problems are common. The hairline always rises. Areas of baldness around the incisions are common. For these reasons we never perform coronal lifts on any patient.
Hairline or modified hairline browlifts do not raise the halrline, but the scar can be visible. Depending on how it is performed, the scar can be visible or minimally visible.
Below is a book chapter in the textbook Mathes that goes into some more depth on many of the methods available to lift the brow, and its relationship to the midface as well.
Endo vs Open brow lift
A coronal and an endo brow lift are both good operations in the right patient. The endo has less incisions, usually avoidspotential numbness of the scalp and avoids potentatial alopecia of an open brow lift. But may not last as long.
Endoscopic vs Coronal Browlift
Theoretically the coronal browlift will last longer because excess skin is removed. With the endoscopic approach the skin is simply elevated and fixed. The disadvantage of both procedures is hairline elevation, especially with endoscopic surgery. Consider a tricophytic browlift where the incision is made at the hairline to maintain or improve hairline position. Hair will grow through and in front of the incision to improve the hairline.
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Endoscopic vs Coronal Brow Lift
First let me say that your surgeon is partly right. The coronal brow lift has advantages over the endoscopic lift. However, it is not due to failure of the fixation devices since many different fixation methods are used.
The coronal brow lift involves an incision from ear to ear across the scalp. The tissue is elevated off the bone to the brow level, Small cuts are make in the periosteum, the tissues elevated, the excess is removed and the incision is close. The advantage is that the excess tissue is removed. The down sides are the large incision and numbness of the scalp behind the incision.
The endoscopic brow lift uses 3 or 5 incisions about 2cm long perpendicular to and behind the hairline. The tissues are elevated in the same fashion as the coronal lift then fixated to the the bone using various techniques. The tissues stick down very quickly. The down side is that there is no excess tissue excised. The benefit are that it's much less "invasive" then the coronal lift and the incisions are small and well hidden.
Endoscopic Browlift results longevity
I have also found that the majority of my patients would be willing to exchange a millimeter or two of elevation of their brow (if that was in fact the case with endoscopic techniques) after having explained to them the extent of the surgery and the resultant incision that is required using the coronal browlift procedure.
Does an endoscopic browlift last as long?
It depends who you ask. I try to discuss different options with my patients and discuss that different physicians may approach any problem in various ways. There are plenty of doctors who do coronal brow lifts and swear that their results are superior to and last longer than doctors (like myself) who try to steer patients to small incision lifts. Personally, if it was me, I would prefer having a brow lift with the smaller incisions. Personally, I do not believe that one type of browlift lasts longer than another.
Endoscopic Brow Lift Vs Coronal Brow Lift
This represents an area of controversy in facial cosmetic surgery. There are those who feel that a coronal brow lift will last longer than an endoscopic brow lift. Most proponents of this view attribute this increased duration to the resection of excess skin.
In contrast, many surgeons feel that an endoscopic brow lift can be equally effective if performed properly. They feel that the results are excellent when adequate soft tissue release and appropriate fixation are utilized. They also feel that the longevity of brow elevation under these circumstances can be equivalent to an open brow lift procedure.
Proponents of endoscopic brow lift feel that a more relevant question is related to the final aesthetic result. They argue that the open approach is associated with more scarring, more numbness, more hair loss and elevation of the anterior hairline.
In the final analysis, the surgeon’s sense of aesthetics and artistry are more important than the technique utilized. Both procedures have a place in the management of brow descent. In the majority of patients, the open traditional brow lift offers no advantage over endoscopic brow lift. It’s important to find the technique that is best for each individual patient.
Endoscopic Brow Lift vs. Full Coronal Brow Lift
Although a more invasive procedure, a coronal brow lift really does have lasting power due to the procedure actually removing excess skin. An endoscopic brow lift does not last quite as long due to the fact that there is no removal of skin, there are just several small incisions that tighten and pull back the brow. This is not to say that with the right surgeon an endoscopic brow lift cannot last a long time, because it absolutely can.The reason people prefer endoscopic more these days is because of the less invasive technique, however, a coronal brow lift still has significant lasting power in comparison.
Coronal vs endoscopic brow lfit
A properly done endoscopic brow lift should last a lifetime. The same could be said for a coronal lift. That being said, not all endoscopicand coronal brow lifts are the same....
Longevity of Endoscopic Brow Lift
In my opinion, and in my hands, I believe that an endoscopic brow lift has great longevity. There are two basic forms of brow lift: endoscopic and open. I do not believe that a Coronal brow lift has any relevance in brow lift surgery given that there is a better open brow lift option: the Trichophytic Brow Lift.
A Trichophytic approach utilizes and irregularly irregular wavy pattern that mimmicks the natural hairline and a bevelled incision to allow hair growth through the eventual scar. A Trichophytic approach allows for skin removal and allows for stabilization or lowering of the hairline. A Coronal approach allows for skin removal, but by definition elevates the hairline. A Trichophytic approach allows for greater control of the glabellar muscles and brow elevation than an endoscopic approach.
However, a properly performed endoscopic approach with complete brow release has yielded excellent results for my patients and saves operative time in the circumstance of multiple procedure cases. A large percentage of patients prefer to have a smaller incision if possible, making the endoscopic brow lift the preferred approach in patients with a normal hairline. Patients with a high hairline require a Trichophytic approach.