Endoscopic or Full Forehead Surgery to Lift Eyelids?

Is endoscopic or full ear to ear forehead surgery the best choice to lift the eyelids? I have no forehead wrinkles but skin over (outside) of brow needs lifting

Doctor Answers 14

Browlift Options Should Be Individually Evaluated

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Every case needs to be evaluated individually before determining the best browlift approach. The endoscopic browlift is typically best for having the eyebrows move in an upward and more open direction, while the hairline incision approach has greater control of the positioning of the brows. This is something that needs to be determined between the patient and doctor.

Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

It depends on the hairline

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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.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Endoscopic vs coronal brow lift?

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Coronal (ear to ear) brow lift is more effective but it is more invasive and creates numbness of the scalp.

I usually perform a procedure which is endoscopic ( preserves the nerves) but involves removing the forehead skin in the upper lateral forehead in the prehairline area. This way you get an effective lift and no numbness of the scalp and a minimally invasive procedure.

Different ways of lifting the brow

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Hi Freddie,

From the description that you give of your problem it sounds that less invasive procedures would be better in your situation. An ear to ear forehead lift is not done too often anymore and would be overkill in your case. The endoscopic brow lift may help you, but we often find that it is not the best procedure for all comers. A transblepharoplasty brow lift with an Endotine device may be ideal in some cases and a subcutaneous brow lift via a small incision in the hair line can be easily done with great results most of the time. I hope this is helpful.

Dr. Gantous

Andres Gantous, MD
Toronto Facial Plastic Surgeon
4.9 out of 5 stars 28 reviews

Beware of brow lifts! Focus on the lateral hood!

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Be very careful when asking for a brow lift, you might get it.  If you look up brow lift results in published papers and before and afters you will see that many surgeons successfully lift the brow.  Unfortunately a true brow lift makes patients look scared or surprised!  It is almost never necessary to elevate the medial third of the brow.  Many women actually benefit aesthetically from a slight lowering of the medial third.  On the contrary, there are few women even at your age that would not benefit from elevation of their lateral brow.  The reason for this is probably not what you think.  Much more important than the brow positionand shape is the infra brow skin.  If you look at yourself in the mirror you will see some bunching of skin under the brow next to your eye and a flat shape.  I call this the lateral hood.  The only kind of brow lift that I typically perform  I call a lateral hood lift.  If you gently pull up on your forehead skin above the lateral brow, you will see that a very subtle elevation makes you look younger.  This is mostly because it cleans up the lateral hood.  It is usually necessary to also restore brow volume at the same time as a lateral hood lift to create a beautiful rejuvenated shape.  I hope this helps!

All the best,

Rian A. Maercks M.D.

Endo vs open browlift

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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. Good luck

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Direct eyebrow lift is most effective brow lift method to lift eyelids

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Be certain that you do not need a blepharoplasty to correct eyelid ptosis, hooding of the eyes or Dermatochalasis. If you have excess eyelid skin, removal of the excess eyelid skin and not a brow lift is what is required to correct eyelid hooding.

Brow lift procedures are designed to lift the eyebrow and correct brow ptosis or sagging brow. Brow lifting can pull the eyebrow skin off of the upper eyelids, but usually not lift significantly lax and excess upper eyelid skin.

The eyebrow at its high point-which is the junction of the medial (inside towards the nose) 2/3'ds of the eyebrow with the lateral 1/3rd (outside-toward the ear)-should be about 1 cm above the bone of the orbit-the bone above your eye. In males this distance is typically lower about 1/2 cm.

If your eyebrow is lower than this you have brow ptosis and a brow lift may be indicated.

The most effective method is a direct eyebrow lift through an incision just above the eyebrow-this is done in individuals who have very significant brow ptosis obscuring vision.

An indirect brow lift through an incision at the hairline or endoscopically will hide the incision and lift the brow. However these indirect approaches are less effective at pulling the sagging brow off of the upper eyelid, and recurrance of brow ptosis is more common.


Endoscopic vs. Open Brow Lift

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This is an age old question. Which is better? The reality is that the open brow lift gives a much better, long lasting result. The reason is that sagging brows are the result of excess skin and only the open brow lift removes this excess skin. The problem is that the large incision is very noticeable, especially when the hair is wet. So the endoscopic brow lift gives a good lift with not as long lasting a results but without the noticeable scar.

I would recommend the endoscopic brow lift if the lift is only moderate as in this case.

Temple lift

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The most effective and direct way of lifting the outer portion of the eyebrow to rejuvenate the eye area is through a temple lift. This is performed through a small incision behind the hairline. No foreign materials are used to keep the brows elevated and it is the least invasive approach. It is most often performed under local anesthesia.

Hope this helps.

Min S. Ahn, MD, FACS
Westborough Facial Plastic Surgeon
4.6 out of 5 stars 35 reviews

Probably won't need long incision brow lift; trust an experienced surgeon

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When you are researching surgical techniques, you will gain important information to help you ask better questions during your consultation. I would not recommend brow lift as a method to primarily improve the eyelids, but it does help the eyebrows and heavy under-eyebrow skin. It also improves frown lines between the brows and forehead lines and looseness.

These benefits can generally be obtained with endoscopic, short-scar methods. There are many modifications that may be used. In the situation you describe, lateral temporal lift alone may give the results you seek.

My most important recommendation is not to choose a method, but choose an experienced surgeon and seek their opinions about your options. The operator is more important than the operation.

Sutton Graham II, MD
Greenville Plastic Surgeon

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.