Answer: A tired or fatigued appearance, even when well rested, is often the result of aging changes in the region around the eyes (peri-orbital). Non-surgical options for rejuvenation of this part of the face include botulinum toxin injections and laser resurfacing. For more dramatic and permanent results, brow lift surgery and blepharoplasty surgery are the standard procedures. A brow lift is indicated for elevation of sagging or drooping eyebrows. It will open up the eyes and restore a more rested and youthful appearance. An upper blepharoplasty is often performed with a brow lift to remove residual excess skin. Lower eyelid surgery (blepharoplasty) is also often performed with these procedures, to further restore a refreshed appearance by removing the bulging bags under the eyes.

Answer: An endoscopic brow lift is a "minimally invasive" form of brow lift surgery that is meant to accomplish the same goals as other open brow lift or forehead lift procedures. It is "minimally invasive" in the sense that it is performed through a few small incisions in the scalp and leaves minimal scars. As with other brow lift procedures, the goals are to elevate the level of the sagging eyebrows, to weaken the frown muscles and to reduce the frown lines and forehead wrinkles.

The endoscopic brow lift is performed through a few small incisions just behind the frontal hairline. Through these incisions the soft tissues of the entire forehead are separated from the frontal bone. An endoscope is used to allow direct visualization while deep restraining tissue layers are released and the frown muscles are weakened. The soft tissues are now free and rather than excising any excess, they are lifted and re-suspended and fixed at their new elevated position, usually using temporary anchoring devices. By performing all of these steps through minimal incisions, longer more visible scars and their associated risk of loss of sensation in the scalp are avoided.

Answer: I perform all types of brow lifts. I select the best procedure for each patient based on their individual anatomy and what specific aesthetic improvements they wish to achieve from the surgery. For those who prefer the least invasive approach and who have less severe brow ptosis (drooping) and worry lines, Botox injections may be a desirable alternative to surgery. Botox will soften or eliminate worry lines and will slightly but noticeably lift the brow. The effects are temporary though. When a surgical procedure is indicated, I usually prefer the endoscopic approach, whenever possible. An endoscopic brow lift is best for patients with relatively short foreheads and relatively anterior hairlines. It will effectively lift the brow and allow for permanent weakening of the frown muscles. It is performed through a few small incisions hidden behind the hairline and does not result in as much loss of sensation and scarring as other open approaches. For patients with taller foreheads and more posterior hairlines, I usually prefer an open approach through a frontal hairline incision. This allows very effective lifting of the brow and at the same time reduces the excessive forehead height and pulls the hairline forward. The hairline scar is usually very well concealed but there will be some loss of sensation in the scalp behind the incision. In patients for whom a scar at the hairline is not acceptable, and who are not good candidates for the endoscopic approach, a traditional coronal brow lift would be another option. This is performed through an incision from ear to ear, across the top of the head. For some patients, particularly men with severe brow ptosis and deep wrinkles in the forehead, a direct brow lift through an incision within the forehead crease can yield excellent results with well hidden scars.