Endoscopic Eyebrow Lift
I prefer to speak of eyebrow repositioning rather than lifting, as the latter term may convey the idea of an excessively elevated eyebrow, giving a frozen or surprised expression, far from the natural look sought. The objective here is quite different: to restore the eyebrow to the position it naturally occupied a few years ago, respecting the balance and expression of the gaze.
This repositioning allows for opening the gaze by restoring harmony between the eyebrow and the upper eyelid. The procedure is performed endoscopically, through micro-incisions concealed in the scalp, making any scarring invisible.
Using an endoscope and specific instruments, the forehead is gently dissected, and the periorbital ligaments are released, allowing the tension weighing on the eyebrow area to be relieved. Once the eyebrow is repositioned with precision, the forehead is stabilized in its new position using micro-screws. This maneuver ensures the longevity of the result while preserving a natural expression.
My journey with endoscopic eyebrow lifting
I performed my first endoscopic eyebrow lifts over 30 years ago, after being trained in the United States by Dr. Nicanor Isse, one of the pioneers in this field. Upon returning to Paris, I applied the technique I had learned, which was then considered innovative. However, I quickly identified two major limitations: results that were not very durable over time and a significant frequency of eyebrow asymmetries in the post-operative period.
Facing these findings, I chose to abandon this approach for many years.
But for the past two to three years, I have decided to reintroduce endoscopic eyebrow lifting into my practice. Why? Because, as an oculoplastic surgeon, it now seems essential to me to know how to reposition the eyebrow to enhance the entire gaze. The eyebrow and the upper eyelid form an anatomical unit: treating one without the other often results in a lack of harmony and naturalness.
Current techniques, being more precise and better controlled, allow for achieving results that are both subtle, natural, and long-lasting. It is this evolution, both personal and technical, that I wish to share in this chapter.
What is endoscopic eyebrow lift?
Indications
• Sagging of the lateral third of the eyebrow, giving a tired or sad appearance.
• Weakening of the forehead with marked horizontal wrinkles.
• Skin laxity of the upper face.
• Congenital or post-traumatic eyebrow asymmetry.
• Esthetic request for eye opening, often combined with blepharoplasty.
It is particularly indicated in young to middle-aged patients with still elastic skin, not requiring a full cervicofacial lift.
Procedure description
Anesthesia and preparation
• Type of anesthesia: general anesthesia or deep sedation with local anesthesia.
• Duration of the procedure: 1h30 to 2h.
• Hospital stay: outpatient or one night of hospitalization.
Surgical technique
The procedure is performed using an endoscope, a miniaturized camera introduced under the skin, which allows for precise vision of the structures through small incisions concealed in the scalp (2 to 5 incisions of 1 to 2 cm each).
Main steps:
1. Incisions in the scalp in the temporal and frontal areas.
2. Subperiosteal dissection (at the bone) to the supraorbital ridges.
3. Release of attachments from the frontalis and orbicularis muscles, allowing for proper mobilization.
4. Tissue repositioning and suspension of the eyebrows with deep anchor sutures or resorbable fixation devices.
5. Closure of incisions with resorbable or non-resorbable sutures.
Immediate post-operative course
• Duration of edema and bruising: 7 to 15 days.
• Temporary numbness sensation of the forehead and scalp.
• Moderate pain, well-controlled with simple analgesics.
• Sutures removed between 7 and 10 days if non-resorbable.
• Return to social activities: 10 to 15 days.
• Return to sports: 4 weeks.
Expected results
Duration of efficacy: 5 to 10 years, depending on skin quality and lifestyle.
Possible complications
Early complications:
• Seroma: sometimes requiring drainage.
• Infection: rare, prevented by antibiotic prophylaxis.
• Persistent pain: generally temporary.
• Temporary hair loss around the incisions.
• Temporary forehead or eyebrow asymmetry.
Specific complications:
• Nerve injury: involvement of the frontal nerve (temporal branch of the facial nerve), which may cause temporary or permanent weakness of the frontalis muscle (rarity).
• Sensory disturbances of the forehead or scalp (hypoesthesia or paresthesia) transient or more lasting.
• Insufficient result or esthetic dissatisfaction.
• Long-term recurrence of eyebrow ptosis.
Fees
The cost of the procedure depends on the surgeon’s fees, hospital staff, and anesthesiologist. Likewise, clinic fees and equipment costs must be taken into account. A personalized and detailed quote will be provided at the end of the initial consultation.
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