Endoscopic Brow Lift

Artistry in endoscopic brow lift methods lies in hiding incisions while sculpting deep layers of tissues and even bone structure in order to optimize results. The art is in giving patients a refreshed and optimized to the best “version” of their appearances, and without the stigmata of scars.

Keep in mind that it’s not the technique that is important, but rather the surgeon performing it. Many plastic surgeons are led to believe that a “cookie cutter” approach can achieve best results regardless of the patient’s age, tissue laxity and quality, their unique bone structure, presence of asymmetries or aesthetic goals. The “your name here” procedures are so common, but facial artistry is all about using the right approaches for the right patient. Using the same exact technique regardless of the face is like a Toyota assembly line churning out the same cookie cutter cars over and over. It may work well for cars, but not for faces and this is why the technique should be tailored to patients’ unique anatomy and goals.

Dr. Rad’s endoscopic “ponytail” lifting method is focused on a nuanced result minimizing scarring, downtime and risk of looking “done.” Dr. Rad tailors his approach to patients’ unique anatomy to achieve refreshed and revitalized appearances.

When performing an endoscopic brow lift, Dr. Rad uses the following technique:

1. Dr. Rad’s top priorities are your safety and comfort and he guides each patient step by step through the following process.

2. A forehead and brow lift must be done with light sedation/general anesthesia. Therefore the initial safety steps focus on reviewing your medical history to ensure no major health concerns such as heart, lung, or kidney disease. You will need a preoperative medical clearance by your primary physician and/or cardiologist or other specialists if indicated.

Once you are deemed a good candidate, surgery can be planned, and Dr. Rad meets with you a second time to review the details of the surgery, provide prescriptions, review medical clearances, and answer your questions. Detailed pre- and post-operative instructions are provided and you are thoroughly prepped for surgery.

3. For optimal patient safety, Dr. Rad operates in a hospital-based OR with a board certified anesthesiologist. Once anesthesia is initiated, you’ll feel or remember nothing of the procedure. Dr. Rad further ensures your comfort with an injected anesthetic. This also minimizes bleeding and hematoma risk.

4. Dr. Rad first assesses your forehead, hairline and eyebrow anatomy, and the exact placement of the incision to optimize forehead aesthetics and overall facial proportion. He considers eyebrow and facial asymmetry at rest: while you are standing upright with your eyebrows relaxed, Dr. Rad takes precise measurements and makes markings while double checking to ensure symmetry. The incision is planned along the hairline, a “pre-trichial” approach, although some of the incision may traverse the hair-bearing scalp. The precise pattern of scar is based on the doctor’s thorough assessment of the ideal aesthetic appearance you’re seeking.

5. In the endoscopic technique, small, hidden scalp incisions through which instruments, just wide enough to allow passage of long instruments, are made. All layers of the forehead above the skull bone are elevated and the tissue attachments of the eyebrows are released.

The endoscopic technique is suitable for patients who desire eyebrow elevation and do not have excessively wrinkled skin. In the mini-brow lift (also called “short incision”), short incisions are placed along the hairline and allow targeted lifting of the outer eyebrows. Optimal for women, this technique results in a hidden scar when the hair is worn as bangs.

6. The tissues are then repositioned upward and secured to the underlying bone structure.

7. A light dressing is applied after which you can return home, driven by a friend or family member. The procedure is performed on an outpatient basis in almost all cases.

Recovery is a process of tissue healing and feeling back to normal that requires time. The length of time depends on which facial areas are treated, the complexity of surgery, and individual healing factors. The key principle of surgery that Dr. Rad always adheres to is minimizing surgery to achieve best results, thus minimizing healing and recovery time. Since each case is different, Dr. Rad will make sure to guide each patient through the recovery process with comprehensive information based on your unique situation.

Recovery for an endoscopic brow lift through a coronal approach can require about one week of downtime, possibly longer depending on the extent of the procedures performed. Dr. Rad always endeavors to achieve optimal results with the least down time and we are sensitive to your need to return to normal activities and professional obligations quickly. We recommend an in-person consultation to determine the optimal approach and Dr. Rad will review expectations for recovery time.

This option is not appropriate for every patient. Generally, patients in their 20s to 40s will benefit most from this technique because younger patients do not have as much forehead skin furrowing requiring skin smoothing techniques such as the mini-brow lift or the coronal techniques. Hidden scars, good eyebrow elevation, as well as frown line reduction and smoothing are the main advantages of this approach. Patients also benefit from the relatively short recovery of 4-6 days.

If frown line reduction is performed, or extended release of the periosteum (the tissue cover over the skull) is required, then recovery can last up to a week. Because every patient’s healing ability varies, it is recommended that you reserve a few extra days as a “buffer” so that you can return to your normal activities safely and earlier if normal healing permits.

Care post-surgery is important for both your recovery and results whether at your home or at a hotel. For your safety, as you’ll be somewhat sleepy, you will need a responsible adult to stay with you for at least the first night. If you’re interested in having an experienced private duty nurse, we can help facilitate this care.

Once home or in a hotel, you will mostly rest, although you should be able to perform “activities of daily living,” meaning being up and about and doing basic self care. Since your head will be wrapped, you’ll defer showering until your first post-op appointment with Dr. Rad 1-2 days after surgery.

During the daytime you should walk 10-15 minutes each hour and should not be on bed rest. Pain is relatively mild and most patients need a mild pain medicine to help them sleep. Tissues react with swelling and bruising that distorts facial appearance and causes facial muscles not to work normally, but this is normal and temporary. Cold compresses and head elevation helps with comfort and swelling.

Since nausea is not uncommon after anesthesia, no matter how light the anesthesia given, nausea prevention is essential and straightforward by taking an anti-nausea medicine such as Zofran (Ondansetron). Nausea side effects typically wear off in 24-48 hours. Other side effects of anesthesia include feeling a bit groggy or “out of it”, but this is relatively mild and wears off quickly. Dr. Rad recommends not planning important work-related activities or phone calls as you will not feel your sharpest.

Drinking liquids is most important to maintain hydration. Dr. Rad recommends Gatorade, or Drip Drop and Liquid IV electrolyte replacement powders mixed in water. If neck lift has been done then patients often feel some neck tightness that is normal, common and temporary. You will see Dr. Rad within the first few days to check on your early healing.

Your vision for your results will emerge through detailed consultation with Dr. Rad, meticulous examination of your anatomy, and careful pre-surgical planning. While Dr. Rad’s surgical approach is unique for each patient, the goal of naturalness remains constant.

Over the course of 2-6 weeks post surgery, results will continue to develop with long-term recovery experienced around 6 to 12 months after the procedure. By this point, the majority of swelling and bruising should have resolved, and you should start seeing the full results of your endoscopic brow lift. However, it’s important to note that individual healing rates can vary, and it may take several months for all swelling to completely dissipate and the final outcome to be evident.

To enhance your results and “protect your investment”, Dr. Rad recommends consulting with Dr. Sherber for laser resurfacing, injectable neuromodulators such as Botox or Daxxify, a results-oriented skincare and sun protection regimen, and non-invasive skin tightening with Thermage FLX. Just like regular tune-ups or oil changes to keep your car running well for many miles, you can maximize the “mileage” you gain from your endoscopic brow lift through these maintenance treatments under Dr. Sherber’s care.

To see Before & After results, visit our gallery page.