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Endoscopic Forehead/Brow Lift

See Chapter 3.

1. Assess the eyebrow position from functional and cosmetic standpoint:

a. Many patients mask eyebrow ptosis with volitional efforts. Ask the patient to close the eyes and massage the eyebrows to a resting position. Are the brows low?

b. Look at old photographs. Often brow ptosis has been present since a patient’s teens or early twenties. Old photographs may reveal the patient’s baseline eyebrow position.

c. Analyze the current and desired height and contour of the eyebrow.

Note: Lateral eyebrow ptosis is most commonly associated with visual and aesthetic problems. Lateral eyebrow ptosis increases with age.

d. Determine the action of the corregator and procerus muscles. Decide whether to and how much to weaken these at surgery.

e. Analyze and document preexisting asymmetries and differences in frontalis function.

f. For significant asymmetries, be sure to ask about and examine for dysfunction of the seventh cranial nerve.

2. Discuss alternative methods of brow elevation (direct, mid-forehead, pretrichial, coronal lifts). Discuss alternative methods of making the eyes appear more open (blepharoplasty).

3. Make a full assessment of upper eyelid and tear function, including the presence or absence of true eyelid ptosis and the presence and magnitude of redundant eyelid skin.

4. Consider administering Botox into the corregator and procerus muscles 2 weeks preoperatively to reduce their downward pull on the eyebrow during the postoperative period

Instrumentation

Thirty degree endoscope

Endoscopic browlift sheath specific for each manufacturer of endoscopes

Video endoscopy setup including: xenon light source, high-resolution video monitor, and endoscopic camera

Scalpel (e.g., #15 bard parker blade)

Endobrow dissectors and elevators

Endobrow scissors

Endobrow grasping forceps

Endotine forehead fixation device, drill bits and insertion tool (Coapt Systems, Inc., Palo Alto, CA). Other systems may also be used by surgeon preference.

Surgical stapler

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