Endoscopic Surgery

Cosmetic Surgery Magazine article, posted 2005

The forehead and eyebrows are among the most expressive features of the face. They illustrate what the eyes are telling us and how we feel without saying a word. As we age, sagging muscles and skin produce horizontal wrinkles on the forehead and vertical wrinkles between the eyebrows – causing a person to look angry, tired or sad when they are not. Even Shakespeare acknowledged the unbalanced appearance to the forehead in a sonnet written to his mistress, stating “how thy brow has fallen.” Thankfully, a revolutionary technique in anti-aging surgery called the endoscopic forehead lift restores youth and expression to sagging features around the eyes and upper face.

“The primary goal of endoscopic forehead lift surgery is to rejuvenate the area surrounding the eye.”

The refined endoscopic procedure is a significantly less-invasive technique than traditional forehead lift surgery, which required large incisions across the hairline that potentially disrupted the appearance of the hair and scalp. The minimal incisions from an endoscopic procedure markedly diminish side effects that may occur following traditional surgery. A discreet incision (less than 3/8 of an inch) is made in part lines of the scalp to accommodate use of the endoscope – a thin instrument with a tiny camera on the tip that precisely identifies and corrects drooping facial muscles. The two-hour procedure is performed on an outpatient basis.

The primary goal of endoscopic forehead lift surgery is to rejuvenate the area surrounding the eye, an integral part of our facial appearance. The brow is lifted in a manner that avoids a stretched, pulled-back appearance to the upper face. Subtle improvements are achieved with the endoscopic forehead lift that cannot be achieved with other procedures. The wide-eyed, surprised look (an obvious sign of unnatural facelift surgery) is eliminated.

When we frown or squint, this often produces vertical wrinkles between the brow. As the brow is lowered over the eyes, this can create a stern or angry look. When we are tired or worried, our brows usually raise, producing horizontal wrinkles on our forehead. To understand why these areas sag as we age, we must recognize the changes that have occurred in the facial muscles that elevate and support the brow.

The muscles that lift the brow compose a sling that passes over the head and extends downward over the front of the head. That frontales muscle is the muscle that elevates the brow. Three small but powerful muscles (the corrugator, procerus, depressor orbicularis) pull the brow downward and cause frown or squinting expression. Because the muscle that elevates the brow is so long and is connected to tissue just above the eyebrow, it stretches out as we age and causes the skin to fall downward. This imbalance is the primary cause of wrinkles and can be corrected with endoscopic brow lift surgery.

Endoscopic technology allows surgeons to view and reposition facial muscles to their original position before the aging process. A combination of two different systems comprise the functional endoscopic instrument:

1) an optical system consisting of rod lenses and
2) a fiber optic light system that illuminates the surgical area


Recent modifications in the design of the endoscopic technology have allowed surgeons to control and manipulate instruments with more efficiency during surgery.

Without removing any skin, the entire muscle structure supporting the forehead and upper eyes and brows is lifted and tightened, stopping the brow from falling and resulting in a smooth forehead and more youthful eyes. Many patients return to normal activity within a week.