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.
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.
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.
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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.
Endoscopic vs Coronal Brow Lift
This is a very controversial subject in the field of facial cosmetic surgery. Recent surveys of facial plastic surgeons reveal that approximately 50% of the surgeons around the United States perform open and about 50% perform endoscopic browlift. The endoscopic browlift probably does not hold up as well as a coronal browlift because there is no skin that is removed in the endoscopic approach. The more important aspects to consider when performing a browlift are the level of preexisting anterior hairline, presence of frontalis wrinkles, presence of corrugated wrinkles, and presence of dermal atrophy. All of these can be addressed better through a coronal approach, especially if one needs to lower the hairline and place fascia grafts underneath the wrinkles of the glabella. A properly performed coronal lift will heal quite nicely, and the incision is of little consequence, and should be minimally detectable.
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.
Different browlifts for different patients
There are different browlifts that can each achieve a good result but it's important for the surgeon the pick the right procedure for an individual patient. Endobrows can work well in a large group of patients, but not in all patients, and those with a lot of loose forehead skin or with a receding hairline, for example, may get a better result with a more traditional approach. Given that you have already had several consults, I would recommend at this point going with the individual you feel the most comfortable based on your consult and their before and after photos to give you the result you want.
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. 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.