Endoscopic brow lift

I prefer to speak of eyebrow repositioning rather than eyebrow lifting, as the latter term can convey the idea of an exaggeratedly raised eyebrow, giving an air of stasis or astonishment, far from the natural look we're aiming for. However, the objective here is quite different: to restore the eyebrow to the position it naturally occupied a few years ago, while respecting the balance and expression of the eyes.

This repositioning opens up the eyes, restoring harmony between the eyebrow and upper eyelid. The procedure is performed endoscopically, through micro-incisions concealed in the scalp, making scars concealed, whose visibility depends on healing.

Using an endoscope and special instruments, the forehead is gently lifted, and the periorbital ligaments are loosened, releasing tension from the brow area. Once the eyebrow has been precisely repositioned, micro-screws are used to stabilize the forehead in its new position. This procedure ensures a long-lasting result, while preserving a natural expression.

My journey with endoscopic eyebrow lift

I performed my first endoscopic eyebrow lifts over 30 years ago, having been trained in the United States by Dr. Nicanor Isse, one of the pioneers in this field. On my return to Paris, I applied the technique I had learned, which was considered innovative at the time. However, I soon realized that there were two major limitations: the results were not very long-lasting, and there was a high incidence of eyebrow asymmetry post-operatively.

Faced with these facts, I chose to abandon this approach for many years.

But over the past two or three years, I've decided to reintegrate endoscopic brow lifts into my practice. Why? As an eye surgeon, I believe it's essential to know how to reposition the eyebrow to enhance the overall look. The eyebrow and the upper eyelid form an anatomical whole: treating one without the other often results in a lack of harmony and naturalness.

Today's techniques, more precise and better mastered, enable us to achieve results that are subtle, natural and long-lasting. It's this evolution - both personal and technical - that I'd like to share in this chapter.

What is an endoscopic eyebrow lift?

Endoscopic eyebrow lift is a surgical procedure designed to reposition the eyebrows into a higher, more harmonious position, correcting the effects of aging on the forehead and eyes. Performed endoscopically, this minimally invasive technique delivers a natural result with minimal scarring, concealed in the hair.

Indications

Endoscopic eyebrow lift is primarily intended for patients with: - A drooping of the lateral third of the eyebrow, giving a tired or sad appearance. - Weakening of the forehead with pronounced horizontal wrinkles. - Sagging skin at the top of the face. - Congenital or post-traumatic eyebrow asymmetry. - Aesthetic demand for eye opening, often combined with blepharoplasty. This procedure is particularly indicated for young to middle-aged patients with still-elastic skin who do not require a full cervico-facial lift.

Description of the intervention

Anaesthesia and preparation

- Type of anesthesia: general or deep sedation with local anesthesia.

• Duration: 1h30 to 2h.
• Length of stay: outpatient or overnight stay.

Surgical technique

The procedure is performed using an endoscope, a miniaturized camera inserted under the skin, which provides a precise view of the structures through small incisions concealed in the scalp (2 to 5 incisions of 1 to 2 cm each).

Main steps:

1. Scalp incisions in the temporal and frontal areas.
2. Subperiosteal detachment (in contact with the bone) down to the superciliary arches.
3. Release of forehead and orbicularis muscle attachments, allowing good mobilization.
4. Reposition tissue and suspend eyebrows with deep anchors or absorbable fixation devices.
5. Incision closure with absorbable or non-absorbable sutures.

Immediate surgical follow-up

- Duration of swelling and bruising: 7 to 15 days.

• Temporary numbness of forehead and scalp.
• Moderate pain, well controlled by simple analgesics.
• Sutures removed between 7 and 10 days if non-absorbable.
• Resumption of social activities: 10 to 15 days.
• Return to sport: 4 weeks.

Expected results

Results are visible as soon as the edema disappears, around 3^e week post-operatively, and stabilize in 3 to 6 months. The eyes are more open, rested, and the upper third of the face rejuvenated, with an effect often combined with an improvement in forehead wrinkles. Effective life: 5 to 10 years, depending on skin quality and lifestyle.

Possible complications

Like all surgical procedures, endoscopic facelifts involve risks, although these are rare when performed by a qualified surgeon: Early complications: - Hematoma: sometimes requiring evacuation. - Infection: rare, prevented by antibiotic prophylaxis. - Persistent pain: usually temporary. - Temporary hair loss around incisions. - Temporary asymmetry of forehead or eyebrows. Specific complications: - Nerve damage: damage to the frontal nerve (temporal branch of the facial nerve), leading to temporary or long-lasting weakness of the frontal muscle (rare). - Sensitivity disorders of the forehead or scalp (hypoesthesia or paresthesia), transient or longer-lasting. - Insufficient results or aesthetic dissatisfaction. - Long-term recurrence of eyebrow ptosis.

Rates

The cost of the operation depends on the fees of the surgeon, hospital staff and anesthetist. Clinic fees and the cost of equipment must also be taken into account. You will receive a detailed, personalized estimate at the end of your initial consultation.