Overview

In recent years, the surgical approach to the brow or forehead has been advanced by the endoscope, a special viewing instrument that allows the surgeon to see inside the body through very small incisions. Endoscopy has been used for many years in other medical specialties for knee cartilage repair, gall bladder removal, and "band-aid" tubal ligation. When the endoscope is applied to cosmetic surgery, very small incisions are needed to perform surgeries that in the past were performed through longer skin incisions such as the brow lift. Traditionally, a brow lift was performed through an incision in the scalp that ran from ear-to-ear. This procedure, called the "coronal" approach, is still used occasionally. In most cases, however, this approach can be replaced by the endoscopic brow lift, which is less traumatic and entails a shorter recovery period.

Indications

Many people first notice a tired appearance in the region around their eyes as they approach forty. Others may notice that they appear sad or depressed. Still others may notice that they always appear angry or unhappy. This sad, tired or angry appearance may be the consequence of changes in the structures of the brow or forehead. With the passage of time and under the influence of gravity, the eyebrows descend to a slightly lower position over the eyes. This "crowding" of the tissues around the eyes contributes to a sad or tired look. Over activity of the small muscles between the eyebrows can create vertical frown lines that convey an angry appearance.

The Procedure

The endoscopic brow lift is generally performed as a day patient. It may be combined with other procedures, such as cosmetic eyelid surgery and/or facelift.

After anaesthesia is given, four to six small incisions are placed in the scalp a few inches behind the hairline. These incisions measure less than one half inch in length. Your hair will not be shaved for the surgery. It is simply parted to expose the sites for the small incisions. The endoscope, a small hollow tube equipped with a light and video camera, is inserted into one of the incisions. Miniaturized special endoscopic instruments are inserted through the other incisions. The desired changes are made while anatomy of the forehead and the instruments are viewed on a video monitor. The small muscles between the eyebrows that cause frown lines are altered without compromising the expression of the forehead. The eyebrows are carefully elevated and precisely secured at the slightly higher, more youthful position. Care is taken to avoid a "startled" or "surprised" look which is undesirable.

A few stitches or staples are placed in the incisions and a bandage is placed over the forehead and scalp. The operation takes a little over one hour.

The Postoperative Period

The first one to two hours after surgery are spent in the recovery room. When you are fully alert, you will be able to return home in the care of a friend or family member. The following morning, all bandages are removed in our office. The surgical sites are inspected and cleansed, and a lighter bandage is placed. Instructions are given on how to care for the incisions until the stitches are removed in seven to ten days.

The pain following endoscopic brow lift is described by most patients as mild to moderate. Pain medication is prescribed, although this is usually unnecessary after the first day. Sleeping with your head elevated can significantly reduce any discomfort.

There may be mild bruising and swelling which lasts for approximately one week. This can easily be covered with makeup. Most patients return to work and social activities after one week. Strenuous physical exercise is avoided for two to three weeks following an endoscopic brow lift.

Risks and Complications

As with any operation, the endoscopic brow lift has minimal risks and potential complications. However, with highly trained doctors and nurses making up the surgical team, complications are extremely rare. Like all surgery, the risk of bleeding, infection, scarring or an anaesthetic problem is present. The risks and complications specific to an endoscopic brow lift, however, are probably less than with the conventional coronal technique. The possibility of hair loss near the incision is significantly reduced with the tiny incisions used in the endoscopic technique. Numbness caused by injury to the sensory nerves is also unlikely. And, injury to the motor nerves that move the forehead is extremely rare with either technique. Rarely, if the doctor deems it necessary, he must convert the endoscopic approach to the conventional technique during surgery.