The development of the endoscopic brow lift has allow plastic surgeons to elevate the brow without making an incision back in the hair that went from ear to ear, also called a Coronal Forehead Lift. Because excess scalp was removed, there was no need to tact the forehead flap down. In the Endoscopic Lift, the forehead elevation comes after releasing the skin and sliding it up into the desired position. Without some form of fixation, the brow would slip back. There are several different methods to do this, but most all involve anchoring the skin to the skull. The skull itself is never opened into the brain. It is all done in the outer layer. Think of an Oreo cookie as the skull, only one cookie wafer has a hole drilled into it and either a suture or a special anchor is inserted into the hole.