Endoscopic Brow Lift, Direct Brow Lift and upper eyelid Blepharoplasty?

Thank-you for your question. If you've already had an endoscopic browlift performed properly, then a direct browlift isn't necessary. The main difference between the two is that with the endoscopic approach, you can perform a very precise release of all the ligaments and structures that anchor the eyebrow to the bone, allowing it to be better repositioned. The ideal treatment for the periorbital region, consists of analyzing the position of the eyebrow and the skin around the orbit, plus correction of the upper and lower eyelids as needed, providing a much more natural result and youthful expression!

If the endoscopic brow lift is performed well, then there is no need for a direct brow lift, which leaves a scar on the face. Be sure to see facial specialists that do a lot of browlifts (ask for photos), and you should then be comfortable that you will get a nice result.

If your eyebrow position is correct, ie, the eyebrow is above the bony orbital rim, there is no need to do an endoscopic or a direct brow lift. With an eyebrow in its correct position, if there is redundant skin of the upper eyelid, an upper blepharoplasty will correct that and give a good result. If your eyebrow position is too low, there are options. An endoscopic brow lift may elevate the brows one or 2 mm with incision lines hidden in the hairline. Another option is to do a subcutaneous temporal brow lift, which works best in people who have a low hairline, and is a very powerful operation for elevating the brow to its correct position. In patients who have a very high hairline or no hairline, a direct browlift, with the incision placed exactly above the eyebrow, can be a very powerful way to elevate the brow as the brow is right next to the incision. This typically occurs in older patients who have more creases and lines in their forehead, and therefore are more accepting of a very fine scar just above their eyebrow.

I prefer to do incisional brow lifts compared to endoscopic brow lifts. Endoscopic brow lifts do not seem to last very long and they require an anchor that sometimes fail. Direct brow lifts have several advantages. One is that it excises excess skin of the forehead. People who have a very high forehead with large forehead skin need some excess skin resected so the incision is done at the forehead-hairline junction. This will lower the hairline and decrease the vertical height of the forehead. The incision can be extended down in front of the ear and this pulls up the lateral canthal area, which will help with crows feet and the lower eyelids. This can be done at the same time as an upper blepharoplasty or may eliminate the need for an upper blepharoplasty.

Best Wishes,

Gary Horndeski, M.D.

A direct brow lift makes a visible scaring at the eyebrow. Surgeons who push this disfiguring surgery grossly overestimate their sewing skills and fail to understand that their best suturing job still makes unacceptable visible scars. There is no reason on earth to have a direct browlift if you are also getting an endoscopic forehead lift. If you are being pitched on such a surgery, I recommend getting other opinions.

These would typically not be offered together. There are a variety of brow lifting procedures including endoscopic, temporal brow lift, pretrichial, coronal and direct. Which specific brow procedure is best is very anatomy dependent as it takes into account patient age, hairline position, degree of brow elevation needed, and static wrinkles of the face. It is very common that a combination of brow procedure and upper blepharoplasty be done in combination, however this is not typical to perform multiple types of brow lifts, simultaneously, in a single procedure. I would recommend seeking out a consultation with a well-qualified plastic surgeon who can discuss these different brow procedures in detail and offer a surgical plan based on your specific anatomy and goals.
Sean Fisher, MDAesthetic Plastic Surgeon Seattle, WA

Typically an endoscopic brow lift with (or sometimes without) an upper blepharoplasty will refresh the eyes and correctly position the brow. A direct brow lift will leave a scar on the face and is generally avoided. I've included a video I hope you find helpful.