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

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.