What is an endoscopic brow lift?

The endoscopic brow lift is a minimally invasive procedure that is performed to elevate the forehead skin and the eyebrows. This operation is designed to minimize skin incisions, to hide all scars in the hair bearing skin and to reduce post-surgical healing time.

An endoscopic brow lift can be performed for any of the following reasons although it is rare that the operation is used for just one problem;

  • to elevate the eyebrows to a normal position
  • to improve the symmetry of eyebrows if one eyebrow is lower than the other as may happen in injury to the facial nerve on one side
  • obliterate or decrease the horizontal wrinkles on the forehead caused my normal muscular contraction of the muscles that elevate the eyebrows
  • obliterate of decrease the vertical wrinkles in between the eyebrows (glabellar furrows) that are cause by normal contraction of the muscles that pull the eyebrows together and downward.
  • as an adjuvant procedure to upper eyelid rejuvenation (upper eyelid blepharoplasty) to avoid excess skin removal during this process.

Could I benefit from a brow lift?

You may be an appropriate candidate for an endoscopic brow lift for one of the following reasons:

  • You are bothered by the drooping of your eyebrows and your forehead, which may give you a tired or sad look, even though you feel rested and happy
  • Restrictions of your field of vision, because the eyelid skin and / or eyebrows are hanging down too low
  • An asymmetric appearance of your forehead and eyebrows with one eyebrow in a lower position than the other. This may be caused by natural aging or injury to the facial nerve
  • Horizontal lines on your forehead (they may be giving you they may be giving you an unintended expression of worry or concern)
  • Vertical lines between your eyebrows (they may be giving you an unintended expression of dissatisfaction or even anger)
  • You have already undergone surgery for your upper eyelids but but this has not achieved the desired result

How is endoscopic brow lift surgery done?

Endoscopic brow lift surgery is typically performed under general anesthesia. After you are asleep the surgeon sterilizes the area of your hair, forehead and face. Subsequently,  three small incisions are placed behind the hairline within the hair bearing portion on the top of your head. One additional incision is placed in each of the hair bearing portions of your temples. Shaving of the incision sites in not necessary.  The procedure is then carried out with an endoscope. The skin of your forehead is gently lifted from the underlying bone so the soft tissue connections between the eyebrows and the bone are loosened and the eyebrow can be be sufficiently elevated. Once the desired amount of lift is accomplished, the forehead skin is secured in place with special sutures that anchor the forehead skin to the bone of the skull. After the surgery is finished, the incisions are closed with sutures and / or staples.

What can I expect after surgery?

You can typically get up and walk around the evening of the surgery or the following morning, initially with assistance. You should be prepared for moderate swelling and bruising of the skin. The degree of swelling differs markedly from patient to patient. Those with blond hair and fairer skin may expect a little more bruising then patients with darker skin. Either way the swelling and bruising both subside within 1-2 weeks, after which time it is typically hardly notable that you just underwent surgery.

Will I have a bandage or a drain after surgery?

Yes, you will have a bandage after surgery wrapped around your head to apply pressure over the forehead and to minimize the risk of a blood collection under the skin (hematoma). The bandage will be removed a day after the surgery. You will use an elastic bandage for the next few days. The drains placed behind the ear to prevent blood from collecting under the skin will be removed a day after the surgery as well. Removal of the bandage and the drains are typically also pain-free.

Will I be in pain after the surgery?

The endoscopic brow lift is a minimally invasive procedure. Pain after surgery is typically very mild and well controlled with pain medications. You may need to take pain pills for one to five days.

What are possible risks and complications of endoscopic brow lift surgery?

Blood may collect under the forehead skin and may require removal. This so called hematoma may be evacuated with a syringe, or it may require a short surgical procedure for removal.

Numbness of the forehead may occur after an endoscopic brow lift. This usually resolves in 2-6 months.

An injury to the forehead branch of the facial nerve may result in decreased motion of the forehead muscles one side. This complication is infrequent and usually transient.

Infrequently, hair loss may be observed in the areas that the incisions are placed. This is also usually transient and mostly resolves in 3-6 months.

Asymmetry of the eyebrows after surgery may also occur. A mild degree of asymmetry is present in most people and should not be regarded as a problem or complication. Pronounced and persistent asymmetry may necessitate additional treatment or a second operation.

Is it possible that I will need revision surgery?

Although the result of an endoscopic brow lift may be expected to last for years, aging will continue and drooping of the eye brows may recur. This should not be regarded as a complication of the procedure, but as a result of the continued aging process. A second procedure may be desired. This may be another endoscopic or an open brow lift procedure with an incision placed along the hairline. Other reasons to perform a revision procedure may include persistent asymmetry or insufficient lift of the eyebrows.

How long will I be off from work?

Generally speaking the recovery period after endoscopic brow lift is usually short and you may start doing your daily routines as soon as the third day. The swelling and bruising though dependent on the patient is rarely longer than 1-2 weeks and almost never limits patient mobility.

How long can I expect the outcome of surgery to last?

It depends on the age of the patient and the type of the patients skin. The aging process continues after surgery and relaxation of the skin and underlying structures is inevitable. This will lead to drooping of the eyelids and wrinkling of the forehead but it is generally excepted that this takes place after 5-10 years of surgery.