Question: I really dislike the appearance of my forehead. I could grow my bangs out but I’ve never looked good with bangs. I’d love to get a browlift but I feel like you don’t hear much about this procedure. Are there other procedures, like a facelift or Botox, that address the same problems but are better or more popular?

Answer: Botox can certainly be used for treatment of forehead lines, but a facelift or rhytidectomy really does not address the forehead.  Browlifts are a relatively common procedure for me to personally perform, and you may not hear much about them simply because most surgeons have been taught in the more traditional fashion of a coronal browlift where a very large incision is made across the top of the head in the hairline and once we describe this to patients they oftentimes decide they really do not want a browlift.  My personal preference and the technique that I use in virtually all my patient is some form of an endoscopic browlift where very small incisions are made between the hairs up in the scalp and, therefore, no large incisions are necessary.  I would have to evaluate your forehead and discuss the reasons behind why you do not like it before I would be able to give you a definitive treatment option, but endoscopic browlifts are very good at improving the overall appearance of the brows and forehead and they also allow me to remove the muscle between the brows that causes the deep creases in that area; furthermore, in select cases where a patient has an overly tall or large forehead, I can actually drop the hairline at the same time as the browlift by making a beveled, irregular incision along the hairline.  This heals extremely well and is very inconspicuous and overall patients are very happy with this technique.

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Question: It sounds like the endoscopic browlift is performed more often than a regular browlift, but is the regular browlift still recommended for some people?

Answer: A regular browlift is often times recommended for some patients with very heavy soft tissue of the forehead and brow area or the surgeon may feel that the endoscopic technique is just not adequate.  I have found that even in heavy tissue if the surgery is done endoscopically in a rather aggressive manner, we still get excellent results and I, therefore, really do not ever perform a standard coronal browlift.  I do, however, perform a combination endoscopic and trichophytic browlift where an irregular incision is made along the hairline to actually drop the hairline at the same time the brows are elevated.  This is performed in patients with an overly high forehead or high hairline.

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Question: I am wondering if you can give an estimate on how long the results of an endoscopic browlift should last. I had one almost four years ago (I was 58 at the time) and I am now noticing that my forehead and brows are starting to droop again. Is it normal for this to happen?

Answer: I believe that the majority of browlift results will last a lifetime and I also believe that the majority of patients that require a browlift later in life actually started with low-set brows when they were young. Brows do droop a little bit and they deflate as they lose volume from the aging process and this process will continue throughout their life, so the brows will drop slightly over time, but usually patients get enough improvement from a browlift that later in life, even with the additional aging, they typically will not need another browlift. I have had many patients who have had browlifts earlier in life who then see me for facelift and frequently will go ahead and touch up the browlift along the sides to help improve their overall look. This certainly does not mean that we are performing another browlift, but what is called a lateral browlift does help with the harmony of an extended SMAS deep plane facelift, so I will commonly perform these together.

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Question: Do you think that an endoscopic browlift will last a lifetime or would later surgery usually be needed?

Answer: I feel that the majority of brow deflation and descent occurs very early in a patient’s aging even in the late 20s and early 30s. By the time patients are in their 30s or 40s and are considering a browlift, once the browlift has been performed seldom will they have enough descent and further deflation of the brow to warrant another browlift procedure in the future. So, for most of my patients, I will tell them to expect a lifetime of improvement since the brows will always be in a more aesthetically pleasing position then before they had the browlift surgery.

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Question: What exactly is an endoscopic browlift and how is it different from a regular browlift or forehead lift?

Answer: An endoscopic browlift is performed through very small incisions up in the hair and then small scopes that are called endoscopes are placed through these small incisions and used to visualize the tissue as we use special instruments to perform the surgery through these other small incisions in the hair. Therefore, it is called an endoscopic browlift since we are performing it using these endoscopes, and we are lifting the brows. A more standard browlift involves a long incision that starts above the ear and then passed across the top of the head all the way to the other ear. The scalp is essentially reflected downwards to the brow as the soft tissue is separated from the bone. Some muscles are released and the brow is elevated. Excess hair bearing scalp is removed and then the incision is closed with sutures and frequently skin staples. A forehead lift is simply another name for a browlift. There are several other different techniques to perform a browlift including a direct browlift, a midforehead lift, as well as what is called a trichophytic or a hairline incision type of a browlift, and each of these needs to be customized for each individual’s facial features. But, for the most part, I tend to perform endoscopic browlifts on the far majority of my patients. In then those with very high foreheads or high hairlines, I will consider a combination endoscopic/trichophytic (hairline) type of a browlift. I feel it is very important to look for an experienced board certified facial plastic surgeon so that your particular anatomy can be assessed and the best treatment option then can be selected for you.

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