Endoscopic Eyebrow and Forehead Lift

Don O. Kikkawa
Sang-Rog Oh
Bobby S. Korn

INTRODUCTION

The endoscopic eyebrow and forehead lift is one of several procedures utilized to correct ptosis of the upper face, as well as to reduce rhytids in the forehead and glabellar regions. In contrast to the open coronal lift, the endoscopic procedure accomplishes its aesthetic goals with smaller, localized incisions. Although the indications and outcomes are similar, the endoscopic eyebrow lift offers several advantages over the open coronal lift. The smaller incisions in the endoscopic approach decrease the risks of intraoperative hemorrhage, postoperative scarring and alopecia, postoperative hypesthesia, and speed recuperation. This approach can also be offered in patients with thinning hair because the scars can be hidden in selective areas and are less conspicuous than a coronal incision. The endoscopic approach, however, requires a higher level of training, particularly with respect to knowledge of the anatomy and the use of specialized equipment. Nonetheless, it is a powerful technique for the treatment of eyebrow and forehead ptosis and should be in the armamentarium of every oculofacial surgeon.

PREOPERATIVE EVALUATION

Eyebrow ptosis is present when the eyebrow rests below the level of the superior orbital rim.

Figure 15-1. In women, the eyebrows have a higher arch with its apex in line with the lateral corneal limbus. In men, the eyebrows have a flatter arch and is positioned closer to the orbital rim. Before surgery, all patients should have a full ophthalmic exam with special attention to the integrity of the tear film and cornea, as well as any preexisting eyelid malpositions, such as eyelid retraction and lagophthalmos. Patients with a history of dry eyes should be advised of the possibility of their worsening symptoms. The eyebrows should be manually elevated to the desired position to assess the need for concurrent upper eyelid blepharoplasty. The length of the forehead should be noted, and if the patient is adverse to any increase in its length, other options, such as a pretrichial lift, should be discussed. The scalp is examined for alopecia, and men with early male pattern baldness should be warned that scars may be visible later when their hair pattern changes. Panoramic facial photographs should be taken.

Patients should be advised to stop aspirin and other blood-thinning agents for week prior to their surgery, unless contraindicated by their primary care physician or cardiologist. If anticoagulation cannot be suspended, it is our practice to defer elective surgery. Lastly, on the day of surgery, patients are asked to wear clothing that does not require removal over their heads since a head dressing is applied at the conclusion of the case.

SURGICAL TECHNIQUE

Markings and patient positioning

With the patient in the upright position, the amount of brow ptosis is assessed and the superior eyebrow margin marked. The eyebrows are then manually elevated to the desired position, and if concurrent blepharoplasty is to be performed, the amount of skin to be excised is determined. The desired contour of the brow is also evaluated.