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Endoscopic Forehead Lift

Facial aging mostly starts from forehead laxity. Typically, it will then have increased forehead wrinkles or crow’s feet in mild cases and overall forehead and brow drooping that compresses the eyelids and eye tail in severe cases. This may result in a gradual loss of eyelids or excessively short distance between the brows and eyes and then induce typical aging signs such as “flat brows” or “splayed brows.” The surgical solution should be determined depending on the brow–eye distance. If the brows and upper eyelid folds are over 1.5 cm apart, simple double eyelid surgery can be considered first to improve the “tire look” of eyes; if the brow–eye distance is less than 1 cm, double eyelid surgery is not suitable in light of objective conditions whose results might also not be natural. In the latter case, patients should consider receiving forehead lift to lift the drooping brows to a relatively high position and raise the medial margin of the brow toward the lateral one-third to create feminine brow shapes. This can not only sculpt relatively young and soft brows and effectively widen the brow–eye distance to expose the double eyelid folds buried by the drooped eyelids but also preserve the original eye shapes and charms and avoid the potential risks of eyes with unequal sizes or shapes from double eyelid surgeries. Forehead lift will produce effects of both double eyelid enlargement and forehead tightening, which also underpins its most significant difference from eyelid plastic surgeries.

In recent years, endoscopes have been extensively applied to forehead and mid-face lift surgeries. It enters the deep layer of the skin and completely images internal tissues and structures via its high-resolution 4× magnification lens. Endoscopic forehead lift not only presents a clear surgical field for surgeons to avoid possible nerve or blood vessel injuries but also enables surgeons to conduct skin and periosteum separation without blind corners and effectively increases the range and extensibility of facelifts, enhancing the surgical results and improving the duration of the effects. This amounts to the least invasive and safest facelift with comprehensive results at present. During the surgery, 4 or 5 incisions of approximately 1.5 cm are created posterior to the scalp hairline, where the endoscope probe gets through the skin to boost the visual field. Dr. Chuang uses various forehead–periosteum dissectors to detach the forehead skin from the bone to the bilateral brow bridge margins, during which injuries of sensory and facial nerves adjacent to the brows are avoided with the aid of clear images provided by endoscopy. Then, after the overall forehead skin has been released without any tension, Dr. Chuang places a biodegradable Endotine fixation implant at bilateral scallop incisions to adhere the newly elevated skin to the bone, which would also concurrently elevate the brows and eyelids. Finally, the excess or loose scalp skin is excised to achieve long-lasting results. Endotine implants are highly compatible with the human body and are metabolized and absorbed within approximately half a year. It is kind of temporary subcutaneous implants that naturally disappear.

Surgical conditions

Duration

0.5hr
  • Type of anesthesia: IV sedation + local anesthesia
  • Type of incision: 4–5 incisions of approximately 1.5–2 cm posterior to the scalp hairline
  • Recovery: 5–7 days
  • Removal of sutures: 7–10 days

General instructions

No food and water on the day of surgery

0hr
  • Rubbing or pressing the incisions on the forehead and scalp should be avoided for 1 month postoperatively.
  • Hair dying or perming should be avoided for 2 months postoperatively to prevent unwanted irritation or allergy.
  • Very good scalp care should be maintained for 3 months postoperatively to prevent hair loss.

Ideal candidates

  • Patients with brow or brow-tail drooping due to progressive forehead aging.
  • Patients with covered or a loss of eyelids due to downward brow compression.
  • Patients with increased forehead wrinkles and frowning wrinkles as a result of forehead skin laxity.
  • Patients with severe brow compression upon eyes due to a congenital excessively short brow–eye space.
  • Patients who desire to restore their brow patterns while they are young or their eyelids without undermining the spirit and charm of the eye.
  • Patients willing to improve upper eyelid ptosis but unwilling to accept double eyelid surgery.
  • Patients with brow drooping combined with poor brow patterns or uneven eyebrows.

Potential complications

  • Scalp scars
  • Hair loss
  • Temporary scalp numbness or itching
  • Temporary difficulty in closing the eyes
  • And foreign body rejection to the Endotine implant

Surgical advantages

  1. Less invasive and fast recovery.

  2. No risk of nerve or blood vessel injury.

  3. Highly stable and safe result.

  4. Restore the original double eyelid position, which is compressed by the aging forehead.

  5. Application of a bioabsorbable Endotine implant that will improve the surgical results and increase its longevity (lasts for at least 6–8 years).

  6. Able to concurrently elevate the forehead and brows to obtain a comprehensive and natural effect of double eyelids.

  7. Effectively resolves brow unevenness or poor brow patterns.

  8. Can both treat and prevent rapid aging of the forehead.

  9. Can improve forehead wrinkles, frowning wrinkles, and crow’s feet.

  10. The hairline is elevated; thus, it is suitable for patients with sparse hair.

Surgical drawbacks

  1. Possible hair loss at the scalp incisions.

  2. Temporary numbness or itching in the scalp for approximately 3–6 months.

  3. Occasional premature loosening of an Endotine implant or skin reaction.

  4. The eye sockets may become hollower after the eyebrow lift.

  5. An excessive lift may make it difficult to temporarily close the eyes.

  6. The scalp incision is relatively small; thus, the surgical effects may not last as long as those from a coronal forehead lift.

Before & After

These photographs represent typical results, but not everyone who undergoes plastic surgery will achieve the same.

Endoscopic Forehead Lift

After One Week

Endoscopic Forehead Lift + Temporal Midface Lift – Female

Endoscopic Forehead Lift + Temporal Midface Lift – Male

Endoscopic Forehead Lift + Lower Blepharoplasty

Endoscopic Forehead Lift + Lower Blepharoplasty – After One Week