Browlifting is often part of periorbital rejuvenation, whether it is done combined with blepharoplasties or, less frequently, in isolation. The most common type of browlift used today is the endoscopic technique primarily because of the limited incisions used. It’s effectiveness is based on two basic principles, adequate brow tissue release and a method for fixation of the elevated tissues. But because it does not rely on tissue excision for its short or long-term results, it is prone to a higher degree of relapse.
In the December 2019 issue of Plastic and Reconstructive Surgery an article was published entitled ‘Endoscopic Temporal Brow Lift: Surgical Indications, Technique, and 10-Year Outcome Analysis.’ In this retrospective clinical study 159 patients over a ten year period were reviewed. The author’s technique consists of bilateral 6cm incision way behind the the temporal hairline (lateral port) with a central 2cm incision oriented either vertically or horizontally based on the length of the forehead. (anterior port) The lateral port is used for release of the orbital retaining ligament and temporal adhesions through primarily subgaleal plane dissection. The anterior port is used to resect most of the corrugator muscles with nerve preservation through a subgaleal plane dissection also. Temporal scalp is elevated and resected to complete the temporal lift. No scalp or forehead skin is excised at the anterior port. Brow position measurements were performed on before and six months after photographs.
The vast majority of the patients in the study were women close to a average age of 60 years. Of the patients studied, 71 (45%) had the endoscopic temporal lift. By measurements the average brow elevation was nearly 2mms at the three locations studied, medial canthus, mid-pupil and lateral canthus. The complication rate was roughly 1.5% with only one patient requiring a revision.
This study’s endoscopic browlift experience supports the trend towards less invasive methods. (at least as judged by the extent of the incisions) They hypothesize that brow ptosis is less severe than it used to be due to the use of Botox and its tremendous effectiveness in forehead rejuvenation. The consistent near 2mm brow elevation all the way across the brow to the medial area supports that brow lifting can occur in this area without skin removal or specific scalp-based lifting techniques. Muscle resection alone, similar to Botox paresis, can have a brow lifting effect. They also emphasize the significance of subgaleal plane dissection from the anterior and posterior ports which provides easier muscle identification and better support during closure.
The endoscopic temporal browlift is not for every patient. It is contraindicated in the patient with a long forehead or in someone with moderate to severe forehead wrinkles.
Dr. Barry Eppley
Indianapolis, Indiana