An endoscopic brow lift raises the position of the eyebrows and forehead through several small incisions placed behind the hairline, using a camera to visualise the surgical plane rather than opening the forehead through a long incision. It is one of a number of brow lift techniques, and it is not universally appropriate. Which approach suits a given patient depends largely on hairline position, forehead height, and the pattern of brow descent.
What an Endoscopic Brow Lift Is
The procedure involves a small number of short incisions, generally three to five, placed within the hair behind the frontal hairline. A narrow endoscope is inserted through one of these to provide a magnified view on a monitor, while instruments are passed through the others.
Working in the plane beneath the scalp, the surgeon releases the tissue attachments that hold the forehead down, including the periosteal attachments along the upper orbital rim and the fibrous attachments at the temples. The muscles that pull the brow downward and inward, principally the corrugator and procerus muscles, can be addressed at the same time where indicated. The forehead is then elevated and held in its new position while healing occurs, using one of several fixation methods.
Because the incisions sit within the hair and are short, they are generally well concealed once healed. The trade off is a more limited surgical exposure than an open approach provides.
How It Differs From Other Brow Lift Techniques
Brow lift is not a single operation. Several techniques exist, and they are not interchangeable. The appropriate choice is determined by anatomy rather than by preference.
Open or coronal brow lift. A longer incision is made across the scalp, generally behind the hairline, giving direct access to the whole forehead. It allows the most extensive release and repositioning, and it can be used to lower a high hairline or address a high forehead. It involves a longer incision and a longer recovery.
Endoscopic brow lift. Several short incisions behind the hairline with camera assisted release. Suited to patients requiring moderate elevation with a favourable hairline position. Provides less exposure than an open approach.
Temporal or lateral brow lift. Incisions placed in the temporal hair only, addressing the outer third of the brow. Appropriate where descent is limited to the lateral brow and the central brow position is acceptable. A more limited procedure with a correspondingly more limited effect.
Direct brow lift. A strip of skin is excised immediately above the eyebrow. It gives precise control over brow position but leaves a scar directly above the brow, so it is generally reserved for specific situations, including some patients with facial nerve weakness or those with deep forehead creases where the scar can be concealed.
Brow position is also frequently discussed alongside upper eyelid surgery, since a descended brow contributes to the appearance of heaviness in the upper lid. Which of the two, or whether both, is appropriate is assessed at consultation.
Anatomical Factors That Influence Suitability
Several specific features are assessed when considering whether an endoscopic approach is appropriate.
Hairline position and forehead height. This is the principal consideration. Because the incisions sit behind the hairline and the forehead is elevated as a unit, the technique tends to move the hairline slightly backwards. Patients who already have a high forehead or a receding hairline may therefore be better suited to an alternative approach, and those with a low to average hairline are generally more suitable.
Pattern and degree of brow descent. Descent affecting the whole brow is addressed differently to descent limited to the outer third. The amount of elevation required also matters, since the endoscopic approach is better suited to moderate rather than very large corrections.
Skin thickness and laxity. Thicker, heavier forehead skin is more difficult to hold in an elevated position and may be more prone to relapse. Skin quality is assessed alongside brow position.
Underlying muscle activity. Strong activity in the muscles that depress the brow influences whether those muscles are addressed during surgery and how the result is likely to hold.
Previous surgery or scarring. Prior forehead or scalp surgery, or existing scars, can alter the surgical planes and affect which approach is feasible.
Hair density and pattern. Concealment of the incisions depends on hair coverage at the incision sites. Thinning hair in these areas is relevant to the discussion.
What the Procedure Involves
An endoscopic brow lift is generally performed under general anaesthetic. Surgical time depends on the extent of release required and on whether any additional procedure is performed at the same time, most commonly upper eyelid surgery.
Once the release is complete and the forehead has been elevated, the position is maintained during healing. A number of fixation methods are in use, including sutures anchored to the deeper tissues, small bone tunnels, or purpose designed fixation devices. The method used is a surgical judgement based on the individual case.
The incisions are closed and a dressing applied. Many patients go home the same day, though this depends on the anaesthetic, on whether other procedures were performed, and on individual circumstances.
Recovery
Swelling and bruising across the forehead and around the eyes are expected in the first one to two weeks, and swelling commonly moves downward towards the eyelids during that period. Patients are usually advised to keep the head elevated in the early days.
Numbness and altered sensation behind the incisions and across the scalp are common. This typically improves over weeks to months, though a small area of permanently altered sensation can remain. Itching during the recovery of sensation is frequently reported.
Most patients plan around one to two weeks away from work, depending on the physical demands of their occupation and on how visible any bruising is. Strenuous exercise, heavy lifting, and activities that raise blood pressure in the head are generally restricted for a period after surgery, as directed by the treating surgeon. Final settling of brow position and resolution of swelling takes several months.
Risks Specific to Brow Surgery
As with any surgery, general risks apply, including bleeding, infection, wound healing problems, and the risks of general anaesthetic. Risks more specific to brow lift surgery include the following.
- Asymmetry between the two brows, since complete symmetry cannot be assured
- Altered or reduced sensation across the scalp and forehead, which can be prolonged and occasionally permanent
- Hair thinning or hair loss at or near the incision sites
- Under correction or over correction of brow position, including an unnaturally elevated appearance
- Relapse, with gradual descent of the brow over time
- Backward movement of the hairline, relevant to patients with a high forehead
- Injury to the nerve branches supplying the forehead muscles, which is uncommon but can cause weakness of forehead movement
- Visible or widened scars within the scalp
These risks are discussed in detail at consultation, and patients are encouraged to ask questions before making a decision. Ageing continues after surgery, and brow position changes over time regardless of the technique used.
Assessment and Next Steps
Suitability for any brow lift technique is determined by physical examination. Assessment covers brow position and symmetry, hairline position and forehead height, skin quality, muscle activity, upper eyelid position and function, visual field, and general health. Photographs are taken for clinical planning.
Brow lift performed for cosmetic reasons does not attract a Medicare benefit. Fees are provided in a personalised written quotation following consultation, once the surgical plan has been determined.
Dr Mark Hanikeri FRACS (PLAS) sees patients to discuss brow lift surgery in Perth. A referral from your general practitioner or another medical practitioner is required before a consultation for cosmetic surgery.
Frequently Asked Questions
How is an endoscopic brow lift different to a standard brow lift?
An endoscopic brow lift uses three to five short incisions behind the hairline with a camera to visualise the surgical plane, whereas an open or coronal brow lift uses a single longer incision across the scalp. The open approach provides greater exposure and allows more extensive repositioning, including adjustment of hairline position. The endoscopic approach involves shorter incisions but more limited access.
Who is not suitable for an endoscopic brow lift?
Patients with a high forehead or a receding hairline are often better suited to an alternative technique, because the endoscopic approach tends to move the hairline slightly backwards. Patients requiring very large corrections, those with heavy or thick forehead skin, and those with previous forehead or scalp surgery may also be assessed as more suitable for a different approach. Suitability is determined at consultation.
Are the scars from an endoscopic brow lift visible?
The incisions sit within the hair behind the hairline and are short, so they are generally well concealed once healed. Visibility depends on hair density and pattern at the incision sites, and hair thinning or loss near an incision is a recognised risk. Patients with thinning hair in these areas should raise this at consultation.
How long does an endoscopic brow lift last?
There is no fixed duration. Brow position is influenced by continued ageing, skin quality, and underlying muscle activity, and gradual descent over time is expected. Some patients maintain the result for many years, while others experience earlier relapse. No specific longevity can be assured, and this is discussed as part of the consultation.
Can a brow lift be combined with eyelid surgery?
The two are frequently discussed together, because a descended brow contributes to heaviness in the upper eyelid and addressing only one may not achieve the intended result. Whether both are appropriate, and whether they are performed together or separately, is an individual clinical decision based on examination of brow position, eyelid position, and levator function.
Further Reading
- Brow Lift Perth: https://markhanikeri.com/brow-lift/
- Brow Lift and Blepharoplasty: Differences: https://markhanikeri.com/brow-lift-and-blepharoplasty-differences/
- Brow Position and Facial Symmetry: https://markhanikeri.com/brow-position-and-facial-symmetry/
- Brow Lift Post Surgery: Results Duration: https://markhanikeri.com/brow-lift-post-surgery-results-duration/
- Lifestyle Factors Affecting Brow Position: https://markhanikeri.com/lifestyle-factors-affecting-brow-position/
- Blepharoplasty Perth: https://markhanikeri.com/blepharoplasty/
| Written by Dr Mark Hanikeri – Specialist Plastic Surgeon, Perth WA. Dr Hanikeri holds Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic and Reconstructive Surgery and has practised in Perth for over two decades. Consultations are conducted at accredited facilities in Subiaco and Murdoch. |
