What Are the Possible Complications of Having Endotine Implants for my brow?

I stopped using endotine years ago for the following reasons:


They can be felt as a firm bump for months after surgery

They add a significant cost to the surgery which is passed on to the patient

They show no benefit to other methods of fixation (i.e. bone tunnel)

Endotines are used by some surgeons who perform endoscopic browlifts. Endotines are like carpet tacks. After the forehead and scalp are lifted, the endotines are placed beneath the skin to hold everything in place. I performed many endoscopic browlifts and though I prefer to use a different method of "fixation" there is nothing wrong with those that use the endotines. The biggest issue with them is that they can be felt beneath the skin for up to 3-4 months. Rarely, they can be seen. The main drawback is cost which is often passed onto the patient and can be around $300. Extrusion and infection should be extremely rare. A well performed endoscopic browlift is equally as effective as open browlifts in most instances. 

There are many different techniques for fixation in the endoscopic brow lift.  I have used the "bone tunneling" technique, the "screw" technique, the "no fixation" technique and the Endotine technique.  They all basically do the same thing, keep the skin elevated long enough to allow it to stick down to the bone.  The older Endotines stuck around for up to 2 years which made them annoying for the patients.  The newer Endotines dissolve in about 2-3 months and are therefore much less problematic.  And, they are very easy to use. Is there anything wrong with the other techniques? No, they're all fine.  What matters is how comfortable your surgeon is using the technique he has chosen.

In addition the number of of transverse cuts in the periosteum (the layer of tissue just above the bone) will determine how well the tissue can be elevated. 

The Endotine device is not a Forehead (Brow) lift technique but a way to hold the elevated forehead in place until mature scar forms and holds it there. The endotine has two surfaces; one that has a small peg which pits inside the outer table of bone of the skull (holding it in place) and a multi-spine surface which engages the underside of the forehead deep (galea) layer holding it suspended in place. In addition to the potential complications associated with the specific Forehead Lift utilized the endotines are palpable for up to 5-6 months (until it dissolves) and may even be visible as two bumps (Not quite a "Hellboy" appearance). The endotines may cause local inflammation, may become infected and in very rare cases in very thin skin individuals may puncture through the skin.

What you must know is that there is no ONE ideal way to fold the forehead in place. The fact that there are still so many ways to do it, instead of a one asccepted norm, should tell you that there is no ideal way and surgeons use the method which served them best.

The complications depend on the approach that is used but are generally similar to a normal brow lift. However, some patients with thin skin have found the Endotine to be palpable (easy to feel) under the skin, until the product dissolves.

I personally do not use endotine for browlift procedures. I have been doing brow lifts for close to thirty years. I do 99% of my brow lifts with the endoscopic technique with simple screw fixation. The screws are very small and are removed from the small hairline incisions 7 days post surgery. I have found this fixation to be more then adequate and patients have a very high level of satisfaction with minimal downtime. This allows a natural look elevating the brows to their pre aging position without over elevating or removing any skin. Endotine fixation that I have seen come in my office from other surgeons have had less then desirable results in my opinion. The foremost complaint that I have seen is a palpable implant post operatively that lasts for many months. Again I did not place these implants in and I can not say if this was surgeon error in placement or just typical of the implants. I do know that these issues usually resolve themselves as they dissolve. I hope this is of some help to you. Best regards!

The possible complications secondary to the use of the endotine device in brow lifts are similar to those which are possible with any brow lift procedure.  Infection, failure of the lift. and asymmetry are possible, but rare. The device is temporary because it will dissolve. Others have said it is palpable, but we place the device under the hair-bearing scalp where it is less apparent.

  IMHO, most likely complication is that they will loosen... loosing their effect...followed by extrusion through the skin or a localised infection due to a foreign body response to the permanent suture.  Might want to conside a Coronal Brow Lift that remains the gold standard for Brow Lift procedures.  You may want to be certain that the plastic and cosmetic surgeon performing your Brow Lift understands and follows the proper aesthetics of facial beauty.  When these aesthetic principles are ignored, the brows can be elevated in the wrong position or amount giving the face a surprised or startled appearance that's not attractive.