What's the difference between an forehead lift and an endoscopic forehead lift? Which one is better?
Forehead Lift Vs. Endoscopic Forehead Lift?
Doctor Answers 40
Consider Limited Incisison Lateral 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.
The Male Browlift
As opposed to the female brow, a man's brow is aesthetically acceptable at, or even slightly below, the orbital rim. The male brow may or may not be arched laterally, and most commonly it is relatively horizontal in orientation. In cases where the male brow has descended well below the orbital rim, and the upper lid tissues appear heavy and redundant, a browlift can be an effective means of rejuvenating the upper third of the face. A great deal of care must be exercised, however, to avoid overdoing and thereby feminizing a male brow.
Although men are much less often good candidates for browlifts than women, endoscopic or trans-blepharoplasty removal of the corrugator (or vertical frown line) muscles is as applicable to males as it is to females, to permanently soften or completely eliminate vertical frown lines between the eyebrows.
Endoscopic Lifts have slightly quicker recovery but open techniques last longer
There are a number of alternative surgical techniques for lifting sagging brows. The endoscopic technique utilizes several smaller incisions in the scalp to tunnel beneath the forehead and 'release' the brows. The sagging brows along with the skin of the forehead are then shifted upwards and resuspended in a more youthful position. No skin is removed. In the open technique, a longer continuous incision is made across the scalp, the tissues are lifted, 'frown' muscles are weakened, and a strip of redundant skin is removed in order to permanently lift the brows. This is the key difference between the two techniques.
The controversy in recent years has centered on whether the endoscopic technique can achieve as lasting a result. Since the stretchy skin is only shifted upwards and not removed, there is a greater chance that the brows will settle lower with time. This is especially true for someone with heavy tissues and thick skin.
One important thing to understand is that the endoscopic technique not only shifts the brows but also shifts the hairline upwards. If you already have a 'high' forehead, this may not be such a good thing. So, the endoscopic technique may be a good option if you have thin tissues and a normal to low hairline to begin with. Of the different open techniques, the trichophytic incision is a really wonderful approach. This incision hugs the hairline in such a way that the hairs grow back through the scar. It can achieve a great natural result and can even lower the hairline for those who've noticed it creeping backwards over the years. If done correctly, the incision should be essentially invisible.
Forehead Lift Differences
There are several approaches to rejuvenating the forehead including endoscopic and open approaches. The best approach usually accounts for several factors:
Hairline- Patients with high hairlines may benefit from a hairline lowering procedure (open approach), while some endoscopic techniques can alter hairline.
Concomitant Procedures- Patients with an endoscopic midface lift are often best served with an endoscopic browlift.
Office Setting vs Operating Room- Some patients may wish for only lateral brow elevation. This can be done in an office setting quite comfortably for the patient.
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Forehead Lift vs Endoscopic forehead lift. Which is better?
Certainly, there is no uniform answer to this question, and good doctors will disagree. Some will argue that the results are not as dramatic with the endoscopic approach but others will argue that the advantage of small incisions vastly overwhelms any such advantage achieved with the long incision "open" technique. Another alternative is a small incision non endoscopic forehead lift which can frequently be done with the same small incisions as with the endoscope but at reduced cost. Hope this helps!
Endoscopic forehead lifts are superior to open methods
Endoscopic forehead lifts are a very common procedure in my practice. It has been my experience over the past 12 years that they are superior to open procedures for several reasons. With the exception of people who have very heavy brows, the results are at least equal and often better than with open methods. Advantages of the endoscopic method include:
1. 3-5 small incisions behind the hairline versus long scalp or hairline incisions
2. Shorter surgery time
3. No issues with hair loss
4. Considerably fewer problems with scalp numbness
5. Potentially reversible
6. Equal access to the frown muscles and ability to add fascia or fat grafts in the frown muscle area.
7. Very minimal elevation of the hairline
Open methods of performing forehead lifts cause more numbness, elevate the hairline, frequently cause problems with hair growth around the scar, and cannot be reversed. Becasue of these reasons I strongly recommend endoscopic procedures for the forehead for the majority of patients.
Endoscopic vs open browlift
I honestly did not have great longevity with the endoscopic browlift and have gone to doing most of my browlift open. It is a long scar but it usually heals beautifully and my patients have not had any long term complaints regarding sensation changes. The advantage of the open technique is the great exposure of all the vital structures and the longevity of the results. For patients with hair line issues (many men for example), I often do a transblepharoplasty brow lift using Endotine fixation devices. These provide a modest lift which is what looks best in men as too much elevation makes them look too feminine.
Brow Lift: A Hairline Decision
As other posters have noted the terms brow lift and forehead lift are interchangeable. However, the technique that is used is predicated on the position of the hairline. If a patient has a low or normal hairline, the endoscopic (minimal incision) approach is generally favored; it allows the case to move along more quickly and offers less recovery time. However, if a patient has a high hairline, the Trichophytic (irregular beveled incision, along the hairline) approach is favored, because it will stabilize the position of the hairline and allow for brow elevation. I do not utilize the coronal approach because it combines a large incision with an elevation of the hairline.
There is no question that an endoscopic forehead lift is the best approach
It astounds me that surgeons continue to offer open forehead lifts. In the early 1990's the endoscopic forehead lift essentially replaced the open forehead lift. The advantages were much faster healing, no long term scalp numbness, loss of hair, and no need for a scar that extends over the head from one ear to the other.
Older surgeons have resisted the transition to the closed or endoscopic forehead lift. The open forehead lift is fast and it is effect, perhaps too effective ( think deer in the headlifts). To be it is execusable to continue to offer the open forehead lift. These surgeons have a lot of excuses why they persist in doing open forehead lifts.
My advice is find a surgeon who will do the forehead lift closed. The results last just as long as the open forehead lift, healing is much faster, there is essentially no hair loss, and numbness is extremely unusual.
There are trade-offs between forehead lift and endoscopic forehead lift
It sounds as if you are talking about a forehead lift done with a coronal or side-to-side incision across the scalp versus one performed through small incisions in 3 or 4 strategically located areas of the scalp. Each have advantages and disadvantages.
The main difference is the length and amount of incisional scar. The coronal lift is certainly effective at the price of a long incision and scalp numbness and some potential for loss of hair. The endoscopic lift has the advantage of small scars but perhaps less long-lasting effectiveness and less nscalp numbness, although some surgeons would disagree.
Get opinions from a couple of surgeons and then allow them to help you decide how to get the result you are looking for. Ingeneral, if you can achieve the results with the endoscopic lift, then that would be the less traumatic and risky. If you or the surgeon don't feel you can, then the coronal lift is certainly tme-honored.
Types of Forehead Lifting - Endoscopic and other
I recently wrote a three part editorial series on Forehead lifting as well as eyebrow procedures. I discuss in great detail how this works. I think rather than repeat myself, you can check out the link below. I am sure you will find it helpfull.
Dr James P. Bonaparte
Facial Cosmetic and Reconstructive Surgery
Head and Neck Surgery
Ottawa, Ontario, Canada
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.