Mr Neil Toft

Consultant Plastic Surgeon

BSc MBChB MD FRCS (Plast)

 

0845 094 5657

 

 

ENDOSCOPIC BROW LIFT INFORMATION

General Background

Endoscopic brow lift is used to elevate the eyebrow region and generate a more youthful appearance of the eyes and face. Many plastic surgeons simply refer to this operation as an "endobrow". As patients become older together with the effects of gravity, the eyebrow descends in a downwards direction which is unattractive. This often causes hooding of the eyes and a sad or stern appearance of the face. Small elevations of the eyebrow (less than a centimetre) can make a dramatic improvement in appearance.
The operation is performed with small incisions hidden in the hair and with a surgical telescope known as an endoscope. The brow area, after elevation, is then secured with deep dissolving stitches under the skin. Endobrow operations are often used in conjunction with facelift procedures and upper eyelid reductions - upper blepharoplasty.


Before the operation

There is nothing special or complicated to be done by the patient. If you are on the oral contraceptive pill or HRT you should continue to keep taking it, and inform the surgeon or anaesthetist in the hospital. It would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before and after the operation. If you dye your hair it would be advisable to visit the hairdresser one week before your operation to have tinting/colouring performed.


The operation itself

Patients normally come into the hospital on the morning of surgery. The operation is performed under general anaesthetic and takes about one hour. It not possible to do this operation under local anaesthetic. When you wake up you will have five small incisions hidden in the hairline which will have been closed with dissolving stitches. There are no dressings. Patients are required to stay in overnight.

Post-operative follow-up and after care

Many but not all patients experience a mild headache for about 48 hours afterwards. This problem can be helped with painkillers and resolves spontaneously. The following day your hair will be washed with help from the nursing staff prior to going home. When washing your hair at home you need to be careful when drying your hair, and should use the dryer on a cooler setting that usual. Often the scalp area is temporarily slightly numb, and it is possible to cause heat damage to the scalp with a hot hair-dryer. Return of normal sensation to the scalp may take a few weeks. Please avoid bleach-based colourants on the hair for 6 weeks after surgery.
It is important to rest and take it very easy for at least 2 weeks after the operation and it is essential to avoid all strenuous activity during this period - this includes all sexual activity.
The stitches will dissolve by themselves, but you will be seen in the clinic at one week to check that all is well. You wound be advised to take 10 days off work to allow any swelling and bruising to settle. It is critical that you do not bend down and lower your head as this increases the possibility of bleeding and bruising. Vigorous sport such as jogging or the gym should be avoided for 4 weeks. A check-up clinic appointment at 3 months after the surgery will be arranged for you.


Complications

All operations carry a risk of complications, although in endobrow procedures these are rare. There will be small scars hidden in the hairline which heal well and with time become almost invisible. Occasionally the scars may be red for a few months but they usually settle down by themselves without any treatment. Very, very occasionally there may be small areas of alopecia (minor hair loss) around the scar. This is often temporary and resolves spontaneously.
The risk of infection is low, about 1 %, and responds well to antibiotics. Significant bleeding is very rare. As discussed above many patients experience a headache for about 48 hours only, with no recurrence in the future.
It is important to elevate the eyebrows by a similar amount. Often patients may have mild asymmetry in their brow height prior to surgery, and minor differences can be corrected. Care is taken to achieve as symmetrical a result as possible.
During the dissection in the forehead, it is possible to damage some of the nerves. The nerves that supply sensation to the scalp can be stretched at the time of surgery, resulting in diminished feeling over the scalp area. This almost always recovers fully, but it may last a few weeks. A branch of the facial nerve over the temporal area of the forehead which allows you to raise your eyebrows and wrinkle the forehead is also susceptible to damage. Great care is taken to avoid injuring this nerve during surgery, and long term problems are very rare indeed.

Summary

Endoscopoic brow lifts are usually combined with either a facelift or upper eyelid surgery. In the right patient they can dramatically improve the appearance of both the eyes and whole face.


Operation Time 1 hour
Anaesthetic General
Nights in hospital 1
Time off work 10 days
Return to normality/exercise 4 weeks