Endoscopic Endotine Brow Lift Made Easy

The Clinical Problem

The aging brow that requires an endo brow lift has to be considered within the aging face as a whole if a rejuvenation procedure is to be successful. A high frontal hairline, a brow ptosis causing visual field disturbance, a heavily wrinkled or creased forehead, a tendency to a poor scar, hair loss, or infection, associated medical conditions, and skin type are reasons to be careful before proceeding. The patient wants minimal surgical intervention and inconvenience and a low-risk, high-reward surgery that improves the appearance of the forehead and position and symmetry of the eyebrows. Often associated with this is improvement in the pseudoptosis of the upper eyelids.

Also associated with the endo brow approach is the final fixation of the elevated forehead. This can be accomplished using screws, an Endotine fixation device (MicroAire Surgical Instruments, Charlottesville, VA), and sutures and may involve the use of fibrin spray technology.

I believe that an endo browlift combined with a four-lid blepharoplasty can produce the most dramatic rejuvenation of the face. It can also be used for facial palsy correction. The brow lift should always be carried out before upper lid reduction; otherwise, an upper lid skin shortage may result.