What is endoscopic brow lift surgery?
A brow lift is usually performed by a plastic surgeon.
A brow lift is an aesthetic surgical procedure to correct the loss of soft tissue elasticity in the upper third of the face. Excess sagging skin around the forehead causing drooping (ptosis) of the brows and wrinkling of the forehead is removed by repositioning the underlying muscle and tissue. It creates a more refreshed, youthful appearance in the upper third area of the face. It can also be combined with a facelift. A brow lift is usually performed by a plastic surgeon.
Endoscopy is the insertion through a surgical incision of a flexible tube with a lighted camera and surgical instruments. The endoscope is now used in a variety of reconstructive and cosmetic surgical procedures. Endoscopic brow lift surgery has gained widespread acceptance, is minimally invasive, and heals faster than traditional brow lift surgery.
Why do people seek endoscopic brow lift surgery?
Aesthetically, the face is divided into three equal parts, of which the forehead (from the top of the eyebrow to the anterior hairline) occupies the upper third. In males this area averages 7 cm and in females it averages 5 cm.
The male eyebrow is less arched than the female eyebrow. The top of the eyebrow lies approximately 2.5 cm from the mid pupil. With aging, these parameters may shift. A lesser distance denotes eyebrow drooping (ptosis).
Loss of forehead skin elasticity from genetics, sun damage, and gravity causes eyebrow drooping, with resultant upper eyelid drooping and dissatisfaction with the appearance.
Aging causes depletion of the subcutaneous fat. This leads to forehead wrinkling, the direction of which depends upon the underlying muscle.
Why is endoscopic brow lift surgery done?
- Aged appearance: Patients may worry they have a tired, surprised, worried, or an annoyed look, appearing older than their actual age
- Eyebrow drooping: Patients may feel an uncomfortable weight of tissue on their eyes
- Forehead wrinkling
- Eyebrow elevation
- Improve eyebrow symmetry
- Change eyebrow shape
- Decrease the function of muscles causing brow wrinkling
When should endoscopic brow lift surgery be avoided?
Endoscopic brow lift surgery should be avoided with:
- Conditions causing dry eyes
- Excessive brow elevation after upper eyelid surgery
- A tendency for keloids or thick scarring
- Psychological instability
- Unrealistic cosmetic expectations
- Poor general health and systemic conditions
What happens during the endoscopic brow lift procedure?
Before the procedure
- Routine blood and radiological investigations will be done.
- Patients may be advised to shampoo their hair with antibacterial soap/shampoo the night before or morning of surgery.
- Hair does not need to be shaved.
During the procedure
- An endoscopic brow lift is performed under general anesthesia or with intravenous (IV) sedation and local anesthesia.
- Multiple small incisions are made just behind the hairline (most surgeons make 3- to 5-cm incisions), through which the endoscope and instruments are inserted.
- Brow tissue is gently released and elevated.
- Excess tissue is removed.
- The muscles are elevated, pulled up and anchored to the bone using anchors made of titanium which look like small screws of 2 mm width. They may be temporary or permanent and do not cause permanent damage.
- The incisions are sutured and dressed.
- A small surgical drain may be inserted — a clear tube is inserted through a small incision below the main incision.
After the procedure
- Post-operative pain can be managed with painkillers.
- Antibiotics may be necessary.
- Patients are advised to rest with their head elevated for two weeks.
- Patients are usually discharged the same day or 24 hours after surgery.
- The drain may be removed after 24 hours.
- The dressing may be removed after 48 hours.
- Patients can shower and wash their hair after 48 hours, using mild shampoos prescribed by the surgeon.
- The surgeon may prescribe medicated ointments to apply to the wounds.
- Patients should not use any hair products for at least seven days.
- Depending on the type of suture used, the surgeon will set a removal appointment.
- Temporary bruising and swelling around the forehead and eyes may occur.
- Wound healing takes approximately two weeks.
- The scars generally heal well and are barely visible.
- In the first few weeks after surgery, the brows may appear to be excessively elevated, but this will settle with time. The final brow results may take four to six months to appreciate.
- Patients can return to work, resume all usual activities including sports and exercise after 10 to 14 days.
How long do endoscopic brow lift results last?
The results last for an average of five to seven years. Traditional brow lift surgeries last longer, around 10 to 15 years.
What are the complications of endoscopic brow lift surgery?
Complications from this procedure are rare. They include:
- Swelling and bruising
- Hematoma (collection of blood)
- Seroma (collection of fluid)
- Mispositioning or change in shape of the brow
- Recurrence of brow ptosis
- Forehead contour irregularities
- Alopecia (loss of hair)
- Numbness around surgical site (usually temporary)
- Temporary or permanent paralysis of the forehead muscle
- Injury to the eyes
What are the alternatives to endoscopic brow lift surgery?
Botox (botulinum toxin) injections may be used, but the results are temporary and must be repeated every four to six months. This is less expensive and less invasive, and it does help to decrease forehead wrinkling. The results of surgery are longer-lasting and can be more dramatic.