Some surgeons use a special surgical drill to make tiny openings in the skull for an endoscopic forehead lift, but it can be done with sutures, as well.
In many cases a hole will be drilled in the outer layer of the skull in order to anchor a suture, endotine device or another fixation device. The skull is composed of two layers and is thick. An experienced surgeon can perform this maneuver safely. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon