It’s not news that as we age everything on our body tends to wander due to gravity.  If this is news, now you know and you have something to look forward to as you get older.  The eyes are the first place on the face to begin to show signs of aging.  Crow’s feet form around the eyes due to repetitive expressions and small lines begin to stretch across the forehead in a patient’s mid to late 20′s and sometimes even earlier depending on  the patient’s genetics and skin care discipline.  In a patients 30′s the eyebrows can migrate closer to the eyelashes decreasing the amount of the eyelid that is visible.  Starting in a patient’s 30′s and going forward the skin loses its elasticity and the excess skin on the eyelids coupled with shifting fatty deposits in the face can cause the eyelids to droop and become troublesome.  In some more severe cases the eyelid can be so heavy and loose that it can actually impair the patient’s vision.  So many patients come to me as an Oculofacial Plastic Surgeon to discuss their eyelids and are thrown when I mention an endoscopic browlift.  When they look in the mirror their eyelids are the problem and fixing them is the solution.  Sometimes this is the case while for other patients the lids are only part of the problem and an extra step must be taken in stabilizing the brow.  The endoscopic browlift is a highly specialized surgery designed to do just that.

The main goal of the browlift is to stabilize the brow.  This means positioning the brow back into its natural and youthful position which is on the brow bone.  This prevents further descent of the brows over time which in some patients is inevitable especially when I surgically address the excess skin or drooping on the eyelid.   The added pressure from the brow can create heaviness and skin redundancy on the eyelid and also cause an angry or cold expression on a patients face.   The browlift stabilizes the space between a patient’s eyebrow and eyelashes.   Another benefit of the brow lift is the smoothing of the patient’s forehead.  Some patients find that after a browlift they no longer need to get Botox® treatments in their forehead.  Most patients have some degree of asymmetry in their brows naturally which can be improved during the surgery as well.  The endoscopic browlift can be done alone while in most cases it is combined with other surgeries in order to maximize results as it is with my Eyelight™ Blepharoplasty.

During an endoscopic browlift four small access sites are made just inside the hair line above the forehead.  The incisions are about a half inch in size and heal even smaller causing minimal scarring that is concealed by the natural hairline.  Using the endoscope a small fiber optic lens, externally attached to a camera and monitor, is inserted and helps with visibility.  Other small tools are guided through and I am able to work externally with the help of the camera to perform the browlift. 

The procedure is performed in the operating room and takes approximately 30 minutes to complete.  Patients are educated about downtime, healing, discomfort and the benefits of every surgery that I perform.  The endoscopic browlift is minimally invasive and with such small incisions the patient enjoys very little scarring and downtime.  Within the first week a patients swelling and bruising will be resolved by 85% and will continue to heal over the next couple of weeks.  Patient discomfort ranges from virtually no pain to tenderness to mild pain around the incision and the forehead.  Most patients find their pain levels to be tolerable and some opt not to take the prescribed pain medication because they feel fine and would like to get back to driving and other daily activities that can be restricted while taking pain medication.  The benefits of the endoscopic browlift is minimal scarring, less bleeding, virtually no hair loss, and very little instance of numbness in comparison to the open techniques where the patient’s incision extends from ear to ear through the hairline.  Two weeks after an endoscopic browlift, patients are released to their full activity level.  Most patients return to work in days to one week after surgery.

This is an actual patient's before and after surgery picture. This patient had an endoscopic browlift, upper eyelid ptosis repair, and laser skin resurfacing of the eye area. Notice the increase in the space between her eyebrows and eyelashes and the softening of her expression. Before Surgery (Upper) After Surgery (Lower)

Many patients want to know if they are going to look “surprised” or have a dramatic and unnatural brow.  The benefit of making four small incisions allows me to adjust the brow medially and laterally which keeps the brow looking natural by aligning its new position with your natural eyebrow contour.  Some surgeons offer fewer incision sites which may seem appealing but can often leave patients with a harsh and abrupt arch to their brow which can look unnatural and overdone. 

As with any surgical procedure it is important to select a surgeon that is specialized in the type of surgery in which you are interested.  As an Oculofacial Plastic Surgeon I feel the endoscopic browlift is a wonderful procedure that offers exceptional results with minimal downtime and may be used to accentuate and extend the results of eyelid surgeries such as blepharoplasty and ptosis repair and other cosmetic surgeries.  An endoscopic browlift gives my patients a natural and rested appearance in the space between the brows and eyelashes; softening harsh expressions, and reframing the face in a pleasing and youthful way.