Forehead lifts (or browlifts) are an important part of overall facial rejuvenation. There are several types of browlifts, including coronal, anterior hairline, direct, suprabrow and endoscopic. With the exception of the
Endoscopic Browlift, all of the other methods require fairly extensive incisions (coronal browlift and anterior hairline browlift) or incisions that are located in fairly visible locations direct browlift and suprabrow browlift). The coronal incision is located several inches back from the hairline, but the scar goes from ear-to-ear. The anterior hairline incision runs along the length of the anterior hairline, where the forehead meets the scalp. The direct browlift incision runs from one side of the forehead to the other. This technique is usually reserved for older patients with extremely deep forehead creases. In these cases, the scar will usually blend in with the other deep creases on the forehead. The suprabrow browlift involves incisions located directly over the eyebrows and is also often reserved for older patients with deep forehead creases. Because of the extent and visibility of the incisions with these more traditional browlifting methods, patient acceptance was quite low. This limited patient acceptance
In the mid-1990's, the
Endoscopic Browlift was developed. The endoscopic browlift is a form of minimally-invasive surgery, where the incisions are quite small and, therefore, are relatively imperceptible when they healed. The endoscopic browlift became the preferred methods for many plastic surgeons, because patients were much more willing to accept five small incisions hidden in the hair, as opposed to the much larger and more visible incisions of the other methods.
The technique involves four or five small (less than an inch) incisions placed an inch or two behind the hairline. The forehead tissues are freed up from the bone, allowing the tissues to be moved upward. Various methods are used to keep the forehead tissues in place once they are lifted. Methods of "fixation" include titanium screws, absorbable screws and other methods. I have been using, for the past few years, a method of fixation known as the
Endotine Method. The
Endotine device is an absorbable, triangular device that has five tiny spikes (or "tines") on the top and a post on the bottom. The post is secured to the bone and the scalp is pulled up and placed firmly on the tines, thereby keeping the brow lifted. The
Endotine devices dissolve in about six months, but by that time the tissues have healed into place and they stay where they are at that point, even thought the device has dissolved.
Minimally-invasive browlifting methods like the
Endoscopic Browlift have led to much greater patient acceptance, and refinements like the
Endotine Device has further improved the success rate with the Endoscopic Browlift. In the past, it was not uncommon to see a patient with a tight face, but with a brow that was droopy. This was because many patients simply did not want the large scar of the coronal browlift. Today, it is rare to see that "disconnect" between a youthful face and an aged brow.
