Mr Guy Sterne, Consultant Cosmetic Surgeon


Endoscopic Browlift


What is an Endoscopic Browlift?

An endoscopic browlift is an operation which tightens the skin of the lower half of the face and neck resulting in a more youthful appearing face.

Who will the operation help?

The skin and soft tissues of the face are held in place by ligaments. With age, as a result of: the continual effects of gravity; the reduced amount of fat beneath the skin; and the tissues becoming more lax - the skin of the face starts to sag between the fixed ligaments, resulting in the classic signs of aging.

Who will the operation NOT help?

A facelift does not rejuvenate the eyes and does not have any significant effect on the skin around the mouth area.

What are the limitations of the endoscopic browlift operation?

When planning a facelift operation it is important to consider the whole of the face. The aim is to maintain, or achieve, facial harmony. As a facelift only tightens the skin of the lower half of the face, the upper half of the face (the forehead and eyes) may then appear to look “older” in contrast to the rejuvenated lower face. For this reason, people undergoing a facelift often combine this procedure with an endoscopic browlift and blepharoplasties (eyelid treatment).
Sun damage to the skin of the face is one of the main factors which can lead to accelerated aging. A facelift only tightens the skin of the face, it does not reverse the effects of sun exposure. However, it is possible, in many cases, to improve the signs of sundamaged skin by a daily skin care protocol using topical retinoic acids.

How is the operation done?

The operation is done under a general anaesthetic (with you asleep). A 3cm long incision is made just underneath and behind the chin, and through this incision any excess fat under the chin is removed and the muscles beneath the chin are tightened. Then an incision is made infront of and behind the ear and the skin is carefully lifted off the cheeks (see picture). A second deeper layer (the SMAS layer) is the raised andit is this layer which is used to lift the face. This layer is stitched up into its new position and finally the skin is redraped and trimmed as necessary. Tissue glue is sprayed under the skin to allow the skin to stick down, avoid bleeding and avoid the need for any drains. Metal staples are used to close the skin of the scalp and removable stitches are used to close the facial skin. The wounds are then dressed with a bulky cotton wool and crepe dressing.

How long is the operation?

An endoscopic browlift usually takes about 1 - 1½ hours.

How many days in hospital?

Most women undergoing an endoscopic browlift stay in hospital overnight and are discharged home the following day.

Postoperative period in hospital

You should rest as much as possible for the first 24 hours after surgery. It is wise not to talk or laugh in the first few days to allow the cheek skin to stick back down and avoid collections of blood or fluid beneath the skin flaps. The bulky dressing will be removed on the first day after surgery and you will be given a pressure “mask” to wear, which will support the tissues until they have properly bedded down. You should wear this constantly for the first 2 weeks (removing it for one hour a day for hygiene purposes) and then during the day time only for a further 2 weeks.
You will be able to wash your hair before being discharged, but must ensure you dry it carefully with a hairdryer on a low heat setting (your nerves will have been disturbed and it is easy to burn yourself without being aware of it).

Postoperative Follow Up

After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse six days after your operation. She will remove any dressings and inspect your wounds, which may or may not have healed at this time. The removable stitches will be removed and you will be given a further appointment to see the nurse about 5 days later. On this visit, the metal staples in your scalp will be removed. If the wounds have healed you will be given an appointment to see me four weeks after your operation. At this appointment I will check on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you in a further month and then arrange a final appointment for about six months.

What are the possible risks?

Any surgery has the potential for complications. Although an endoscopic browlift is generally a very safe procedure, it does carry the following risks:

  • Bleeding: bleeding is uncommon but can occur at any time over the first ten days after surgery, and therefore it is wise to avoid any strenuous exercise over this time. Should a bleed occur under the skin, the face may swell quite dramatically, it can be quite painful and you may develop visible bruising and tenderness. If this happens you usually need to return to theatre to have the blood removed and the bleeding stopped.
  • Infection; infection is uncommon and results in swelling, redness and tenderness along the wound at any time up to 3 weeks after surgery. This usually responds well to a course of antibiotics.
  • Ugly scarring: most wounds will initially be red and a little thickened for the first six months or so, but will eventually settle very nicely to leave a thin, pale, flat scar. Occasionally however, scars may become red, raised, wide, itchy or ugly. This is very uncommon, but any wound breakdown which occurs in the early postoperative period may result in a slightly stretched, flat scar.
  • Delayed wound healing; This is not a disaster, but can leave a somewhat wider scar. Delayed wound healing is more common in smokers and you are strongly advised to stop smoking before your operation, and not to start again (if you must!) until the wounds have finally healed.
  • Alopecia: again this is rare, but if part of the skin which is damaged due to poor blood supply is hair bearing scalp, the hair follicles can die resulting in a bald patch.
  • Eyebrow weakness: this is the worst complication of a facelift. The facial nerve lies just beneath the SMAS layer, and if it is stretched or cut during the facelift, one or more of the facial muscles may be weakened. This nerve is injured in about 0.5% (one in 200) facelifts. Fortunately, most nerve injuries recover on their own after 2 or 3 months, but weakness can occasionally be permanent.
  • Altered sensation; when the skin of the cheeks are lifted the nerves to the skin are often stretched or even cut. Almost inevitably, the skin in front of the ears will be numb after the operation. Initially the patch of numbness will be very extensive, extending up to the chin and cheeks and even ears on occasions, but gradually the size of this area of numbness will shrink to leave a small area of altered sensation just in front of the ears. It can take up to 2 years for this to recover. During this time, it is possible to injure or burn this skin without realising it. For this reason you should carefully inspect the skin of this area regularly, and in particular be careful with hot hairdryers and don’t sleep with earrings in.
  • Irregularities beneath the skin: high tension stitches are used beneath the skin to hold the face up and sometimes firm areas or lumps can be felt beneath the skin of the cheeks. This can be softened after 6 weeks or so by regular massage, and these areas usually settle completely.
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