I have been to two different plastic surgeons for a consultation on a brow lift. They agree on the fact that I need a brow lift but they disagree on the procedure. One has suggested an endoscopic brow lift and the other a coronal brow lift. I am 46 and have low eyebrows but not a significant amount of loose skin on my forehead. The coronal lift seems very invasive but I have heard that the endoscopic lift doesn't work as well. What are the statistics?

Your experience is not unusual and often very good plastic surgeons may recommend different techniques that can provide the same or similar results. In terms of your anatomy, one technique may be better suited for you than the other. Your plastic surgeon will consider your features and expectations, as well as the associated risks and benefits. Both endoscopic and open (coronal) lifts address the problem of low eyebrows. Some surgeons prefer the endoscopic approach, while others argue that the endoscopic lift does not seem to elevate high enough or stay quite as long as an open lift. Clinical studies have supported the effectiveness of both techniques. The open lift may be particularly effective in treating horizontal forehead wrinkles. Be aware that either procedure may slightly elevate your forehead and hairline. For most patients, this is not a significant concern.

The endoscopic lift has been around since 1993 and has been shown to be just as effective when performed properly by an experienced and well trained surgeon. It avoids the issues associated with long incisions such as scarring and numbness with less pain. If fixation of the lift is utilized it has also been shown to be long lasting. Sometimes there can be hair loss with either procedure but with the endoscopic lift it is usually focal and can be corrected with a small excision later if necesssary.

I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead – if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious.

In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.

While I used endoscopic browlift techniques for several years to treat brow descent, more recently I have transitioned to performing a limited incision lateral browlift that does not require the use of an endoscope. The relatively short incision is hidden behind the temporal hairline, and no incisions are required in the scalp directly above the eyes. The advantage is as follows: this approach allows me to not only redrape the lateral brow (conservatively!) in a higher position, but it also allows me to reposition the skin and soft tissues of the lateral periorbital area in an upward direction, producing a more complete rejuvenation of the periorbital area. Additionally, through this same incision I can perform suspension of the midface (cheek) if that is part of the surgical plan.

Different Types of Browlifts – As you age, different types of browlifts are needed. For example, a patient may need an endotemporal browlift if they have lateral brow ptosis only. Infrequently, I do a full coronal browlift unless the patient has good hair, a low brow, or have significant rhytids and want significant brow elevation. I perform this operation which is less than 10% of my patients currently.