After consulting 6 surgeons for face, neck and eye surgery, only one wants to do a coronal brow lift. Is this safe and successful compared to an endoscopic brow lift?
Coronal Brow Lift Vs Endoscopic Brow Lift?
Doctor Answers 16
Endopscopic versus open brow lift
You have asked a very relevant and controversial question, so my answer is long, but hopefully, thorough.
When endoscopic brow lift was introduced about 10-12 years ago, all the meetings gave the impression this is now the "way to go" since it has smaller incisions and potentially can leave the sensation in the scalp intact. It was said if any one performs the open technique, that doctor "lives in the dark ages"! The problem was, if one looked at before and after photos, NONE of the patients needed a brow lift, and all the eye brows were raised too much, with that "surprised" look.
As time passed by, the presenters at the meetings now say that the patient selection is critical for endoscopic brow lift. To me this means this technique is not what it was touted to be. The gold standard is still the open brow lift.
There are two types: one is coronal, with the incision at the center of the scalp. The other is the hair line, with the incision at the hair line. I prefer the hair line since it does not lengthen the height of the forehead (the coronal can pull the hair back resulting in a long forehead). Also since the distance from the incision to the eye brow is less, one has better control over how much lift the brow can achieve.
I agree the open brow technique is still the gold standard, and has withstood the test of time.
Coronal Browlift, Endoscopic Browlft or Later Browlift
If there is a facial rejuvenation surgery that is over-recommended and often overdone these days, it is without question the browlift. Look no further than the celebrity photo magazines for pictures of stars who look like they have just sat down on a plate of tacks. The goal of aesthetic plastic surgery should be to make a person look better and more youthful, not merely different, and certainly not as though one is perpetually surprised. My goal is to provide my patients with results which appear natural, and an unnatural-appearing brow is a dead giveaway that a person has had facial plastic surgery.
I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead – if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious.
A youthful, feminine brow rests above the level of the orbital rim, which is the upper margin of the bony socket in which the eye resides. An aesthetically pleasing brow is somewhat arched laterally, and the lateral end or "tail" of the brow is higher than the medial end. It is quite common for the female brow to assume an essentially flat or horizontal orientation as a person ages.
If the skin and soft tissues lose enough elasticity with age and sun exposure, the lateral brow may even descend to a level below the orbital rim, producing a tired or even 'surly' appearance. The medial brow is relatively fixed in position and in most cases does not descend much, if any. In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.
While I used endoscopic browlift techniques for several years to treat brow descent, more recently I have transitioned to performing a limited incision lateral browlift that does not require the use of an endoscope. The relatively short incision is hidden behind the temporal hairline, and no incisions are required in the scalp directly above the eyes. The advantage is as follows: this approach allows me to not only redrape the lateral brow (conservatively!) in a higher position, but it also allows me to reposition the skin and soft tissues of the lateral periorbital area in an upward direction, producing a more complete rejuvenation of the periorbital area. Additionally, through this same incision I can perform suspension of the midface (cheek) if that is part of the surgical plan.
Rejuvenation of the brow by means of a lateral browlift will also, in most cases, improve the appearance of the upper eyelids. When the lateral brow is repositioned above the orbital rim, the vertical elevation may eliminate the appearance of wrinkled or 'crepey' upper eyelid skin. If the lateral upper lid skin is 'hooded' over the lateral corner of the eye, this improves as well. While upper blepharoplasty (upper lid skin excision) is often performed in concert with a lateral browlift, for many patients the upward positioning of the brow eliminates the need for skin excision.
Coronal vs. endoscopic brow lift
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 doctors (like myself) who try to steer patients to small incision endoscopic lifts. Personally, if it was me, I would prefer having a brow lift with the smaller incisions.
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In the Majority of Patients, the Open, Traditional Browlift Offers No Advantages Over Endoscopic Browlift
This is a very difficult question to answer without the benefit of a physical examination or patient photographs. Each patient needs to be considered individually and the best option varies from patient to patient. In our experience the best choice of procedure depends on several factors. These include the patient’s aesthetic goals and the specifics of their forehead anatomy. In some cases, the surgeon’s experience with a particular technique may also contribute to his recommendation.
Brow Lift surgery has historically been performed by making an incision across the top of the head from ear to ear, and pulling the skin in an upward direction. The excess skin is removed and the brow is fixed in its new position. The muscles that cause frown lines are treated as well.
In contrast, endoscopic brow lift is performed through several small incisions placed behind the hairline. The procedure is performed with an endoscope accomplishing the same goals as the open technique. A fixation device is utilized to hold the brow in its new position.
In severe cases of brow descent, the open approach has the advantage of being able to raise the brow more than the endoscopic approach. In addition, the skin may be more easily mobilized with this technique and fixation is not an issue because the excess skin is actually resected.
In contrast, the major advantages of the endoscopic brow lift are less scarring, less numbness, less elevation of the hairline, and less hair loss. The procedure is much less invasive and associated with much shorter recoveries.
It’s important to realize that both techniques require adequate mobilization of the scalp and appropriate fixation to maintain the brow’s new position. The surgeon’s sense of aesthetics and artistry are important with either technique. Both procedures have a place in the management of brow descent. In the majority of patients, the open traditional brow lift offers no advantages over endoscopic brow lift.
The descion you and your surgeon make about which forhead lift is best for you depends on numerous variables. Without photos, it is difficult to give you an accurate answer. The forehead lift that will ultimately be best for you depends on your concerns with your hairline position, placement of inscicions, and desired outcome.
There are many methods for performing a browlift or forehead lift including an endoscopic browlift (through tiny incisions with the assistance of telescopes) , bicoronal forehead lift (extensive incision from ear to ear across the top of the head) and a tricophytic or hairline browlift. (hidden along the hairline. Each of these techniques achieves a similar result through the brow and the forehead in terms of smoothing of lines and gentle elevation of the brows.
The key difference is in how they affect your hairline. The Bicoronal (ear to ear) browlift elevates or pulls your hairline back, raising the frontal hairline by up to one inch. The Endoscopic lift has minimal effect of the position of the hairline. The tricophytic or hairline browlift can be used to adjust the hairline, usually lowering it to address a receding hairline or widow's peaks in the temporal hairline.
Best of luck!
Coronal vs endo 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.
Brow lift, coronal approach vs endoscopic
The coronal brow lift is a very safe and successful operation compared to the endoscopic brow lift. The coronal approach gives more predictability and has less revision rate than the endoscopic lift. With the coronal brow lift, the hairline can be either moved up or down depending upon placement of the incision. The hairline can be brought forward ½ inch through an incision at the pretrichial area. Precise surgical adjustments of the corrugator frontalis and procerus muscles can be also performed at the same time. Fascia grafts can be inserted in the corrugator area for dermal atrophy when needed, which gives an excellent result. The frontalis muscle can be softened as well as the procerus. These procedures are all impossible to perform under endoscopic techniques.
Coronal vs Endoscopic Browlift
The choice of coronal vs endoscopic browlift depends on the experience of your surgeon and your individual needs. Excellent results can be achieved with both. The disadvantage of these tecniques is they will elevate your hairline. A trichophytic (hairline) incision will maintain or improve hairline position with the browlift operation.
There are various types of brow lifts, which have arisen over the years.
The most popular is the endoscopic approach, which has been around for over 10 years at this point. Other approaches, like the coronal have been used for decades. Variations of these approaches, such as trichophytic approaches also exist.
There are pros and cons of and indications for each type or approach. The endoscopic approach is the most popular, since it avoids problems with long scars, hair loss at the incision, and generally has a shorter healing time than coronal lifts.
Coronal lifts can give a more powerful lift. Howevere, most patients really don't need that degree of elevation. Trichophytic lifts are used in patients with high and elongated foreheads, since it moves the hairline forward, closer to the eyebrows.
Hope you find the choice that is right for you.
Best of luck
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.