Subgaleal Endoscopic Browlift with Absorbable Fixation

Abstract

The browlift has been a part of the aesthetic surgeon’s armamentarium for rejuvenation of the upper third of the face for almost a century. Early descriptions by Passot [1] recommended excision of ellipses of skin along the hairline to raise the brow and soften crow’s feet. Since then, numerous approaches have been developed to address the ptotic brow and smooth forehead rhytids, including coronal, trichophytic, midforehead, direct brow, endoscopic, and transblepharoplasty techniques. In modern aesthetic surgery, the coronal incision with subgaleal dissection and myotomy of the procerus, corrugator, and frontalis was initially the gold standard [2–5]. However, since the first published descriptions of the endoscopic browlift in by Isse [6], there has been a strong trend toward approaching the upper third via minimally invasive techniques. Indications for browlift have traditionally included ptotic aging brow with or without upper lid dermatochalasis, elimination of glabellar and frontalis rhytids, and avoidance of temporal bunching in revision facelift [7]. Occasionally, there is a functional indication for unilateral brow lift such as with facial nerve paralysis. Despite the fact that most coronal brow lifts are performed in the subgaleal plane [2–5,7,8] many investigators espouse endoscopic brow lift in the subperiosteal plane [6,9–15]. This could be attributed to early technique reports, which suggested a more favorable optical chamber could be achieved with a subperiosteal dissection [12]. However, an early endoscopic report by Isse [16] describes either subgaleal or subperiosteal dissection to 3 cm above supraorbital rims and then subperiosteal dissection around the neurovascular bundles.