Endoscopic and non endoscopic
internal brow and forehead lifts
An internal brow lift is often used in middle aged patients with moderate amounts of brow ptosis. Although originally used in cosmetic surgery, internal forehead lifts with or without the aid of an endoscope has been used successfully in patients with mild functional brow ptosis due to certain diseases e.g. facial nerve palsy. Not only does it elevate the eyebrow, it also smooths out the forehead wrinkles. These internal brow and forehead lifts involve the release of the the descended forehead and eyebrow off the underlying bone of the forehead, sometimes with the aid of a rigid endoscope. Five small incisions behind the hairline are performed to allow release of the upper forehead to allow dissection of the retaining ligaments of the forehead soft tissues. These incisions heal to leave fine scars hidden within the hair. The tissues are then elevated and secured using a variety of fixation techniques. In addition to being able to release the retaining ligaments of the forehead and brow, an internal brow lift also allows for partial removal of some of the wrinkle and furrow causing muscles of the eyebrow and bridge of the nose. 
Although commonly performed both in the UK and US, it does have certain recognised disadadvantages including relatively high cost, moderate permanence of effect and long procedure time. Compared to some of the newer less invasive procedures, full internal forehead and brow lifting is also associated with significantly longer recovery and greater postoperative discomfort. Increasingly, it is being recognised that the surgery associated with a full internal forehead lift e.g. a full forehead dissection is probably not necessary and that what is more important is the reliability of the fixation technique to secure the tissues in their elevated state.
Many surgeons are now recognising that the newer more reliable fixation techniques to elevate the eyebrow and forehead can also be employed e.g. endotine forehead fixation devices, without the cost and morbidity associated with performing a full internal forehead lift using an endoscope. In addition, many feel that the extreme amounts of lift associated with such extensive forehead dissection often result in an unnatural eyebrow giving a surprised, windswept look and that what is more important now is more subtle recontouring of the eyebrow shape instead i.e. less is more.
Overall Mr Cheung will tend to reserve this technique when there is generalised mild to moderate drooping of the eyebrow. For the more commonly seen temporal brow droop i.e. descent of the tail of the eyebrow, Mr Cheung prefers newer less invasive techniques e.g. transblepharoplasty brow lifting.
These operations are not suitable for patients with a high hairline due to scalp incisions. Patients can usually return back to normal activities 2 weeks following surgery.
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