Endoscopic Browlift, A Technique That Has Stood the Test of Time: Seventeen Years of Experience

Goals/Purpose:  Since the advent of endoscopy for rejuvenation of the upper third of the face, there has been an increase number of patients seeking less invasive procedures and refusing the extensive scar of the coronal approach. The use of injectables has also risen dramatically, however the cost remains of primary concerns for repeated applications, and patients are seeking more definitive treatment.  We present our technique for the endoscopic browlift and summarize our 17 years of experience, treating patients presenting with eyebrow ptosis, asymmetry and fronto-glabelar lines.

Methods/Technique: The superior third of the face is treated following two vectors of traction. The first vector is vertical, elevating the medial forehead structures after subperiosteal undermining up to the level of the glabella. Then undermining is continued in a supra periosteal plane in order to treat the procerus, corrugators and depressor supercilii muscles. Three fixation points using non-absorbable 2-0 sutures (with the aid of a surgical needle with an eye at the end to place the suture), are placed in the scalp to reposition this region. The second vector is superior-oblique, elevating the lateral brow and orbital region after undermining the temporal region in an interfacial plane up to the superior temporal line. Then traction of the superior temporal region is performed by fixing the superficial temporal fascia to the deep temporal fascia with non absorbable 3-0 sutures.

Results/Complications: Between January 1995 and January 2012, 880 patients (782 women, 98 men) benefited from our technique of endoscopic browlift, 76% of which had additional cervico-facial lift. Their age ranged from 23 to 86 years old with a mean follow-up of 9.3 years. Complications included 2.2% cases of temporal hematoma, 3.4% cases of brow asymmetry, 6% cases of temporary paresia of the frontal nerve. Five percent patients underwent a second procedure at a mean of 6.5 years after their primary procedure. Eighty-eight percent of patients reported that their appearance was very good after their procedure.

Conclusion: Endoscopic browlift is an effective technique, providing simple adjustability and optimal elevation and symmetry of the eyebrows. It significantly improves the frontal lines and the wrinkles on the bridge of the nose and on each side of the nose. It does require a learning curve, but has the advantage of presenting with low rates of complications and great satisfaction for patients and surgeons. Although in the long term, some muscular activity may return, it seldom returns to the preoperative state and results have shown to be long lasting.