How is an endoscopic browlift different than a traditional brow lift or forehead lift?
What is an Endoscopic Brow Lift?
Doctor Answers 51
Lateral Browlift, Less Invasive, Better Results than Endoscopic Browlift
If there is a facial rejuvenation surgery that is over-recommended and often overdone these days, it is without question the browlift. Look no further than the celebrity photo magazines for pictures of stars who look like they have just sat down on a plate of tacks. The goal of aesthetic plastic surgery should be to make a person look better and more youthful, not merely different, and certainly not as though one is perpetually surprised. My goal is to provide my patients with results which appear natural, and an unnatural-appearing brow is a dead giveaway that a person has had facial plastic surgery.
I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead - if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious
A youthful, feminine brow rests above the level of the orbital rim, which is the upper margin of the bony socket in which the eye resides. An aesthetically pleasing brow is somewhat arched laterally, and the lateral end or "tail" of the brow is higher than the medial end. It is quite common for the female brow to assume an essentially flat or horizontal orientation as a person ages.
If the skin and soft tissues lose enough elasticity with age and sun exposure, the lateral brow may even descend to a level below the orbital rim, producing a tired or even 'surly' appearance. The medial brow is relatively fixed in position and in most cases does not descend much, if any. In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.
While I used endoscopic browlift techniques for several years to treat brow descent, more recently I have transitioned to performing a limited incision lateral browlift that does not require the use of an endoscope. The relatively short incision is hidden behind the temporal hairline, and no incisions are required in the scalp directly above the eyes. The advantage is as follows: this approach allows me to not only redrape the lateral brow (conservatively!) in a higher position, but it also allows me to reposition the skin and soft tissues of the lateral periorbital area in an upward direction, producing a more complete rejuvenation of the periorbital area. Additionally, through this same incision I can perform suspension of the midface (cheek) if that is part of the surgical plan.
Rejuvenation of the brow by means of a lateral browlift will also, in most cases, improve the appearance of the upper eyelids. When the lateral brow is repositioned above the orbital rim, the vertical elevation may eliminate the appearance of wrinkled or 'crepey' upper eyelid skin. If the lateral upper lid skin is 'hooded' over the lateral corner of the eye, this improves as well. While upper blepharoplasty (upper lid skin excision) is often performed in concert with a lateral browlift, for many patients the upward positioning of the brow eliminates the need for skin excision.
Listen as Dr. Sam P. Most describes the endoscopic brow...
Listen as Dr. Sam P. Most describes the endoscopic brow lift and how it differs from the traditional or open brow lift surgical technique.
Endoscopic vs traditional brow lift
An endoscopic brow lift differs from a traditional brow lift in the following ways:
1. During an endoscopic brow lift several small incisions are made behind the hairline. The incisions for a traditional or "open" brow lift vary in location but are generally larger and may be either within the hair, at the hairline or, in some cases, in the forehead itself.
2. During an endoscopic brow lift, the surgeon uses a camera and an endoscope to visualize the structures under the skin. During a traditional brow lift, the surgeon has direct vision of the important structures.
3. After some types of traditional brow lift, the patient will experience numbness of the scalp. This can be permanent. This should not occur after endoscopic brow lift.
4. The recovery period for both endoscopic and traditional brow lifts is essentially the same with all sutures and clips removed by 7-10 days and a return to normal activities at 2 weeks.
5. Some types of traditional brow lift provide the surgeon with a greater ability to elevate the brow than is possible with the endoscopic approach.
6. Some types of traditional brow lift will change the position of the hair line. This is less likely to occur following an endoscopic approach.
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Endoscopic forehead (or "brow") lift
Endoscopy is largely responsible for the transformation of the face-lift business--not to mention medicine in general. When the magnificent fiber-optic instrument known as the endoscope is used on almost any area of the body, a major operation requiring large incisions suddenly becomes a minor one, requiring only tiny slits.
An endoscope is a tube-shaped probe with a tiny light and miniature video camera on one end. When I insert the endoscope through an incision (which I make as small as a quarter inch), I can see what is going on underneath the skin and view the proceedings on a TV monitor in the operating room. The video allows me to rely on both touch and sight to perform robot like surgery, in which I maneuver the endoscope with one hand and surgical instruments in the other.
I most commonly use this instrument to perform endoscopic forehead or brow lift, which opens and brightens the upper face, smoothes deep furrows and wrinkles in the forehead, softens the vertical scowl lines between the eyebrows, lifts sagging brows, alleviates pressure on the upper eyelid, and even lifts the nose a bit. Because drooping brows and forehead furrows are such evident markers of age and stress as early as one's mid thirties, this procedure is among the most popular I perform.
Endoscopic Brow Lift
An endoscopic brow lift differs from a traditional brow lift in that it is done through tiny incisions within the hairline and endoscopic cameras and tools are used. Traditionally, a brow lift was done with a much larger incision making it more noticeable and numbness of the forehead occurring more frequently. Although the endoscopic procedure's results are not as significant as the traditional procedure, it has become a front runner due to its less invasive nature and reduced scarring.
Endoscopic or an open traditional brow lift?
Read Rod Rohrich's comments on this subject. The traditional open coronal brow lift is still the gold standard in forehead rejuvenation.True the endoscopic scars are of a less length in your scalp by around 50 % but I still am not sure why this is important. There are however limitations on what the surgeon can accomplish endoscopically, such as correcting the frontalis horizontal forehead creases. A lot of experienced surgeons have decided to return to the traditional method as they have been discouraged by the long term results.If you are young (30-40) and want a refreshing look, the endoscopic approach may be the way to go. If you are 40-60 and your eyebrows are sitting on your upper lid eyelashes with a lot of forehead creases go with the open traditional approach.
Browlift surgery was traditionally done with an incision...
Browlift surgery was traditionally done with an incision from ear to ear across the scalp. The forehead is lifted off the bone and the frown muscles are modified to weaken their function. The brow is lifted and the extra scalp is removed. This has worked well and still is the best procedure for certain patients especially those who have very heavy brows.
The endoscopic browlift attempts do do all that the open coronal lift described above does just through tiny incisions and using a television camera to see the structures. The power of this procedure is less than the open browlift but it is usually enough to get a nice result. Unfortunately the studies indicate that 30% of patients with endoscopic browlifts feel that they didn't get as much as they wanted and 30% of the doctors feel the same way.
Now that Botox is so prevalent, browlift surgeries have dramatically decreased in numbers. Frown lines are now treated with Botox rather than surgery and the only reason to have surgery is if your brows are too low.
Differences between lifts
Endoscopic brow lifts eliminates all of these problems.
What is an endoscopic brow lift?
Endoscopic browlift is a technique to elevate the brows through a number of small incisions, typically in the hair bearing scalp using small instruments with a fiberoptic camera. It is basically the same operation that is done through larger incisions known as coronal or pretricheal. I find that the coronal and pretricheal approaches are more reliable then the endoscopic approach. There are no good/reliable ways to keep the brows fixated in an elevated position through the endoscopic approach and that is why I rarely do endoscopic brow lifts.
Endoscopic versus Traditional Brow Lift
The rule of minimally invasive brow rejuvenation is significant in that most patients do not want a significant scar in the brow. Endoscopic or endoscopic temporal is indicated in most patients that require shaping of the brow with corrugator muscle resection. However, if a patient wants significant brow elevation as they have a low hanging brow with deep frown lines then a traditional brow lift is a very powerful and effective procedure.
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