Enhancing youth and boosting confidence by an endoscopic forehead and eyebrow lift

The loss of the elastic tissue in the skin with age substantially causes the skin to hang loosely, especially on the face and neck. Besides a flatter face, sagged soft tissue or broken jawline, deeper nasolabial folds, aging is generally associated with wrinkles in the forehead caused by repeated deformation of the skin, decreased skin tension and eyebrow/eyelid drooping. These undesired skin degenerative conditions result in an old-looking appearance or sad expression and facial tiredness which can profoundly impair self-confidence and quality of life. Instead of conventional surgery, the endoscopic method of rejuvenating the brow-forehead complex has evolved into a procedure, known as “an endoscopic forehead and eyebrow lift”. In comparison to traditional forehead and brow lifting methods, this procedure is considered effective since it is associated with a smaller incision that requires shorter healing time, resulting in faster recover, less scarring and a long lasting effect.  

Traditional forehead and eyebrow lift

Traditional forehead and eyebrow lift (open forehead and eyebrow lift) is a cosmetic procedure to raise the forehead and eyebrows. It improves the appearance of the forehead, the eyebrow and the area around the eyes by raising the saggy or droopy soft tissue and skin of the forehead and eyebrows. Performed under anesthesia, an incision is made above the ear level following the hairline up the forehead to the next ear. The overlapping scalp is then surgically removed and the remaining scalp is sewn together. Carefully lifting the skin of the forehead enables adjustment of excess fat, tissues and facial muscles, if needed. Regardless of its satisfying results in tightening and lifting the forehead and eyebrows, this surgical technique leaves a long surgical scar along the headband line and carries the risk of forehead or scalp numbness, besides longer recovery time is required.

Endoscopic forehead and eyebrow lift

Due to advancements in the endoscopic method of rejuvenation, an endoscopic forehead and eyebrow lift is a minimally invasive procedure that has been developed to achieve major advantages over traditional method. 

After making 2-3 small incisions, sized smaller than 2 cm. hidden behind the hairline, the plastic surgeon inserts a long thin tube with a light and a tiny camera mounted on its end (called endoscope) through one of the incisions to visualize underlying muscles, tissues, vessels and nerves.  Surgical instruments are subsequently inserted through another incision, the plastic surgeon surgically lifts the forehead tissues and anchor them in place with sutures or small screws without cutting the scalp. The incisions are then closed with stitches or small clips. In general, this procedure shortens the operation time to 1-2 hours. Since it requires only few small incisions, it results in faster healing time and less bruising and less damage to the surrounding nerves and tissues than the classic approach. The effect normally lasts approximately 5 years. Nonetheless, individual skin texture and personal lifestyle greatly impact on the surgical outcomes that might vary among individuals. 

Suitable candidates for an endoscopic forehead and eyebrow lift

To obtain a more pleasing appearance, an endoscopic forehead and eyebrow lift is highly recommended for people who have:

• Forehead wrinkles or deep-set forehead lines
• Low, sagging eyelid or eyelid asymmetry
• Droopy eyebrows
• Frown lines or forehead furrows which are deep vertical lines that develop on the forehead
• Previous surgical history of eyelid which an epicanthal fold – a skin fold of the upper eyelid covering the inner corner of the eye becomes thicker than it is supposed to naturally be.

Limitations

An endoscopic forehead and eyebrow lift is not advised in people who have:

• Eyebrow tattoo positioned higher than the natural eyebrow line
• Forehead augmentation or forehead implant using silicone
• Asymmetry in the position of the eyebrows (an endoscopic forehead and eyebrow lift might not be able to correct both eyebrows in exactly the same level.)
• Large forehead with high hairline

Instructions prior to surgery

1. Please keep the surgeon informed about your medical conditions and underlying diseases, including:
   • Medical problems
   • Serious illness or underlying conditions
   • Medical history e.g. surgery and anesthesia administration
   • Dental problems e.g. denture and wobbly tooth
   • Drug allergy or food allergy
2. For patients with high risks or underlying diseases, additional investigations prior to being anesthetized and surgery include:
   • X-ray
   • Blood test
   • Electrocardiography (EKG)
   • Medical consultation with internal medicine doctor
3. Certain medications, supplements or herbal drugs that affect surgery must be discontinued at least 7 days before surgery begins. Please bring all medications and supplements to the hospital on the surgery day. These include:
   • Painkillers and anti-inflammatory drugs
   • Aspirin
   • Vitamin D and vitamin C
   • Cod liver oil
4. Stop smoking at least 6 weeks before surgery to prevent infarction or tissue death due to inadequate blood supply to the surgical site. If you are heavy smoker, please inform your surgeon before surgery. After surgery, smoke cessation is also highly recommended at least 2 weeks.
5. Stop drinking alcoholic beverages at least 24 hours before surgery. After surgery, it is also advised to refrain from drinking at least 1 week.
6. Take a shower and wash your hair prior to surgery.
7. All cosmetic products are not allowed.
8. Food and fluid restriction must be followed as directed by your surgeon. This aims to prevent aspiration that might happen during anesthesia administration.
9. For women, surgery should be avoided during menstruation.
10. Button-front shirt, dress or blouse should be worn on the surgery day as it is convenient to wear while minimizing the chance of injury to the surgical site after surgery.

Post surgery care after surgery

1. To minimize swelling, it is advised to lay on the back while keeping the head up. If experiencing bleeding, medical attention must be obtained immediately.
2. After surgery, a head wrap might be prescribed and worn to minimize swelling, depending on the plastic surgeon.
3. Cold compress using ice pack filled with refrigerant gel or cool water should be applied to reduce swelling at the surgical site after surgery.
4. A week after surgery, full resting is required. Within 5 – 7 days, sutures will be removed. Body showering, face and hair washing can be resumed as directed by the plastic surgeon.
5. After surgery 1-2 weeks, bruising and swelling around the face might develop. It is normally self-limiting, requiring 2-3 weeks to disappear. Incision lines will fade over time. Facial shape will become normal within 1-3 months after surgery.
6. Vigorous hair brushing should be avoided for 6 – 8 weeks
7. To enhance healing process, it is essential to refrain from alcohol and smoking for at least 2 weeks after surgery.
8. Vigorous activities, sports or exercises, such as swimming and running must be avoided for at least 6 weeks after surgery.   
9. Post-operative appointments must be strictly followed.

Relevant risks and possible complications

• Pain or swelling which subsides by pain medications
• Wound infection
• Bleeding at the surgical site
• Delayed or incomplete healing
• Temporary paralysis or hypoesthesia (loss of sensation) of the scalp or face due to nerve injuries.

Despite the fact that an endoscopic forehead and eyebrow lift results in satisfying outcomes that enhance appearance and self-confidence, the procedure poses certain risks if it is not performed by well-trained and experienced plastic surgeon in fully equipped hospital.