The use of the fiber-optic endoscope for performing brow and forehead lifting came of age while I was in my fellowship training and I was fortunate to be on the front end of that learning curve. Prior to 1993, most all brow and forehead lifts were done using a large incision from ear to ear across the scalp that often resulted in numbness of the scalp, hair loss, and a wide, visible scar. The endoscope not only obviated the need for that incision but ushered in a novel perspective for rejuvenating this area of the face. Rather than simply cutting and pulling the scalp, attention was directed on rejuvenating specifically those elements that were the result of aging. The technology improved as did our level of understanding about the aging process, and the “endoscopic browlift” evolved.
My Philosophy on Brow and Forehead Lifts
My current philosophy is to use the scope to allow me to alter a few specific muscles and attachments in order to render a subtle softening of appearance. Although the maneuvers I employ in each case here in Beverly Hills are different, I generally try to attain a similar aesthetic outcome. I prefer the center of the brows to be on the low side yet not too close together. The brows should arch but there must not be too much distance between the brow and the orbital rim, as this can make the person look startled or hollowed out. I usually move the brows out to the sides rather than vertically. The muscles that enable a person to frown are sometimes divided or sometimes left alone. There is no skin removed with my technique.
The brows are secured to the bone in their desired position and any redundant tissues are redistributed backwards over the remaining scalp where there is a greater area to accommodate them. I feel that a well-executed brow lift is more conservative than a blepharoplasty as there is no tissue removed and no visible incisions. Although one might be tempted to think of brow lifts and blepharoplasties as comparable operations with the same goal of improving the aesthetics around the eye they are not. Often times I find that performing both procedures allows for the optimal balance and aesthetics.