Written by Frank P. Fechner, MD
As we age our eyes become more saggy looking and the brows get heavy. The solution may come in the form of a browlift. Over the years, the endoscopic browlift (sometimes also called “endo-brow”) has been labelled as being of “minimally invasive nature … with a recovery that is fast and comfortable”. Interestingly, there are many experienced facial cosmetic surgeons that dispute this claim.
If compared to an open approach, some of the distinguishing facts include:
1. Incision: Endo-brows are usually performed through 5 incisions placed within the hair. Adding them all together, they are commonly somewhat shorter than the one longer incision used in the open browlift.
2. Extent of surgery: During an endoscopic forehead lift, more significantly more dissection is necessary in order to achieve the necessary mobilization of the forehead tissues.
3. Recovery: Most likely, recovery is similar or longer than after open browlift. In fact a recent published article on endoscopic browlifts describes pain, swelling and bruising to last at least 4 weeks in 75% of patients. This is certainly longer than we routinely see after open browlift surgery.
4. Aesthetic outcome: The debate is ongoing… Many facial plastic surgeons feel that the open surgery continues to represent the “gold standard” in forehead rejuvenation. Certainly, softening of frown lines (the “number 11″ between the brows) can be more effectively treated using open surgery; the endoscope may be a hindrance for safe muscle manipulation.
Here is an example of a Endoscopic Brow Lift result – published in September 2012 in the premier facial plastic surgery journal (Arch Facial Plast Surg):
Endo-Brow - Published Result. Procedure Not Performed by Dr. Fechner
In comparison, this is one of our patients after Open Browlift:
Before and After of Open Browlift. Procedure performed by Dr. Fechner
What is the message:
1. We do not seek a procedure, but an aesthetically pleasing outcome.
2. The desired look should determine how and with which procedures we can get there.
Written by Frank P. Fechner, MD
When we thoroughly study the changes associated with facial aging we begin to understand that it actually is as straight forward as we may believe. One insight into this enigma of aging is gained by comparing the different procedures used, both surgically and non-surgically, to counteract changes that time has brought. Although fat grafting was described before, it was only about 8 years ago that a few aesthetic surgeons used fat injections to provide volume to the face for rejuvenation. Until then, the maxim was “lifting – lifting – lifting” until normalcy was entirely removed from a person’s face.
Although perfection is still not available, I believe that we moved much closer to where we really want to be. My view has been that the answer lies not in face lifting or volume. Rather, it is the combination of tightening what has dropped and volumizing what is sunken that will provide the most logical approach with the most natural looks. As a result from this revelation, I perform about 98% of facelifts in combination with some fat grafting.
The injection of fat is a minimal invasive procedure where I extract the fat from areas of abundance (most commonly the hips, lower abdomen or love handles), purified and re-injected into specifically defined facial regions. This fat grafting procedure certainly is challenging technically. In addition, the outcome will only be as good as the esthetic eye of the cosmetic surgeon performing the procedure. Afterwards, the results will hold up for years because the enhancement is provided by living fat cells rather than absorbable fillers.
A lady in her 60s is shown before and 10 months after facial fat injections and browlift.
This patient is 10 months after fat transfer in addition to a browlift and lower eyelid lift. Although no facelift was performed, she appears more youthful and energetic. The hollowed areas have been replaced by softness and the patient’s face seems to “flow” much better.
Written by Frank P. Fechner, MD
The hairline and size of the forehead are very important to discuss before any browlift procedure. Most browlifts are performed in women; browlifts in men requires an entirley different discussion.
Most techniques used for brow lifting (i.e. endoscopic brow lift, coronal browlift) will, by definition, raise the patient’s hairline. Because a somewhat high hairline is common in most women, approximately 80% of our patients we plan the procedure so that the hairline will be constant. When now the brows are lifted CONSERVATIVELY, we effectively decrease the height of the forehead which is desirable. This procedure is called a trichophytic (hairline) browlift.
If the hairline is already very high, hairline lowering can be achieved by advancing the scalp forward. It is a little more work to accomplish this but can be of great value in the right situation.
The scar line after these procedure heal very well if planned and sutured meticulously.