The endoscopic lift was developed in 1992 and was presented at the annual meeting of the American Society of Plastic Surgery that year in Washington DC and published the following year. In the beginning the results were not uniformly good but over time it has become a standard and effective procedure with good results in properly selected patients. I agree with the 10 to 12 year average length of time in terms of the longevity of  results which gradually deteriorate over time. I have seen some patients with only a 2 to 3 year result and I have one patient who is 15 years out and has had no need for relifting. A patients skin type and tissue integrity (i.e. elasticity) can be a actor as well as whether the surgeon uses fixation of the lift which seems to extend the result. 

Forehead Lift

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.

Forehead Lift

Actually the traditional advice of using a pre-hairline incision in patients with a high forehead does not always hold.  In some patients with a high forehead and sometimes even in men with a receding hairline, one can still perform an endoscopic procedure with incisions hidden above the hairline because if the lift is done at a level that goes beneath the periosteum, then the distance between the brows and the hairline remains the same as the entire unit is lifted in continuity, even though the hairline is technically higher.  So, it will still look normal as the distance between the brow and hairline is unchanged.  A subcutaneous lift will definitely increase this distance and the hairline will look excessively high.  

Subperiosteal endoscopic browlifts are very forgiving in terms of this issue although it is better in vertically oriented foreheads as opposed to rounded ones.  It is good to avoid pre-hairline incisions in most patients unless they have hyperactive frontalis muscle syndrome with a rounded high forehead.  In those patients one can perform an endoscopic biplanar technique with a pre-hairline incision.

Forehead Lift

I am a Board Certified Plastic Surgeon who sees many patients just like you and have done body contouring for 20 years.  Although a tummy tuck is not out of the question depending on your health, I would not recommend it as a first line choice.  In reality, even with a perfect surgery and additional liposuction, your improvement with "tummy tuck " surgery would be modest at best and it would actually fall more into the category of a "panniculectomy."  You seem to be seeking a significant improvement in your appearance and this would only make you look "less overweight" as opposed to giving you the look you have sought for so long.  In addition, the procedure would carry moderate risk in terms of deep vein thrombosis and would require several hours at your current weight.  Many surgeons would not perform it all , although there are also a number of very experienced surgeons who would do this if you were in good health,  had no other alternative, and had failed weight loss programs multiple times. So, what is my recommendation?  I have had absolutely excellent results with patients just like you with laparoscopic gastric bypass procedures ( LGB). After all, at your current weight and age, the primary issue is actually living a longer life and you need to do something significant soon or you will have more serious issues due to your weight. The term "morbid" obesity is used because of the secondary morbidity from being more than 100 pounds over ideal body weight. Many patients do not seek gastric bypass due to inaccurate anecdotal stories they have heard.  While there is some risk, it is actually quite small and the overwhelming majority of these procedures are very successful in the hands of qualified doctors.  In addition, there is risk to continuing like you are as well.  If you had LGB, then you would lose around 100 pounds in a year and then you would be an excellent candidate for truly significant body contouring surgery, which would be less risky at a lower weight.  Then you would have both the tremendous change in your weight as well as the health benefits from being closer to ideal body weight. You can find a reputable LGB surgeon through the American Society for Metabolic and Bariatric Surgery (ASMBS).  Lastly, and perhaps most importantly, I would encourage you to find out the answers to any concerns you have about weight loss surgery from the doctors themselves and not websites or friends.  I wish you all the best.

Tummy Tuck