Endoscopic forehead lift: how it works and what to consider

What is an endoscopic forehead lift?

A brow that has sagged downward is called brow ptosis. A drooping brow can make the upper eyelids look heavy or the face look tired. A forehead lift is surgery that raises a drooping brow and forehead; in the endoscopic approach, a camera and instruments are inserted through small incisions in the scalp.

According to a review summarizing 35 years of experience, the endoscopic forehead lift raises the brows, reduces wrinkles, and improves left-right symmetry by carefully changing the balance between the muscles that raise the brows and those that pull them down ^[1]. Wide dissection beneath the lining of the bone (periosteum), down to the level of the cheekbone arch (zygomatic arch) and the eye socket (orbit), is critical to success, and the muscles that pull the brows down are weakened by cutting them (myotomy) so that the brow-raising action of the forehead muscle (frontalis) becomes dominant ^[1].

Another review also explained that controlling the muscles that pull the brows down and dissecting widely beneath the periosteum is the principle behind correcting brow ptosis ^[5]. The endoscopic forehead lift is presented as an established operation that can safely and reliably rejuvenate the upper third of the face ^[6]. However, these are the authors' descriptions, and actual results and risks vary from person to person.

How is it different from other forehead lift methods?

There are many ways to raise the brows. A 2020 review examined 10 methods, including two nonsurgical ones (botulinum toxin and filler), and grouped the surgical options into methods performed through an eyelid incision, the direct brow lift with an incision just above the brow, and forehead lifts performed through the forehead or scalp ^[7]. It stated that the effects of nonsurgical methods are temporary ^[7].

The same review stated that the endoscopic forehead lift is currently the most widely used method, but that it has limits in how long its effects last ^[7]. It also judged that no method is fully satisfactory, because of limited effects, a lack of durability, and the possibility of complications ^[7]. It stated that the direct brow lift is especially useful for patients with facial paralysis or people for whom a scar is more acceptable (men, or people with a high hairline) ^[7].

A 2011 systematic review analyzed 15 studies and reported no clear evidence that the open approach is inferior to the endoscopic approach ^[2]. However, there were no prospective randomized trials directly comparing the two, and the review also pointed out a lack of good comparative studies ^[2]. Therefore, it cannot be said that the endoscopic approach is always the better choice.

Considerations for East Asian patients

A review of forehead lifts in East Asian patients stated that East Asian patients have anatomical and clinical features that should be considered before surgery ^[4]. It stated that, to improve the results of eyelid surgery (blepharoplasty) or surgery to build up the nose, the option of combining it with a forehead lift should be considered in advance, and explained that a forehead lift is often needed even in younger East Asian patients ^[4].

The same review stated that patients prefer the endoscopic approach because it can avoid visible scars, and that when the skin is thick and loose, a modified approach that combines several dissection layers can be used for better results ^[4]. This is an experience-based description from a single review, so the approach that suits you should be decided through an examination.

Fixation methods and complications

The forehead tissue that has been freed needs to be secured in its new position. A 2025 scoping review analyzed 11 fixation methods and 2519 patients across 27 studies ^[3]. The most commonly used methods were fixation through a small tunnel made in the bone (649 patients), absorbable fixation devices (333 patients), suture fixation (906 patients), and screw fixation (216 patients) ^[3].

When complications were divided into cosmetic, nerve-related, wound-related, and other, nerve-related complications were the most common at 11.69%, followed by cosmetic complications at 6.27%, other complications at 4.94%, and wound-related complications at 1.19% ^[3]. Bone tunnel fixation had the fewest complications in all four categories, and screw fixation had the highest complication rate in every category ^[3].

The authors interpreted the overall low rate of complications as supporting the effectiveness of the endoscopic forehead lift, but because studies reported complications in different ways, they could not clearly determine which method is best, and the level of evidence was low, at level IV ^[3]. Among the studies that reported sex, 85.9% of patients were women, and ages ranged from 38.8 to 72 years, so the same figures are hard to apply directly to younger patients or to men ^[3]. The review of East Asian patients mentioned rare but serious complications such as paralysis of a motor nerve and double vision (diplopia), and stated that most were temporary ^[4].

How long do the results last?

Opinions differ on how long the results last. A 2020 narrative review that selected and summarized 56 publications judged the durability of the endoscopic forehead lift to be limited ^[7]. In contrast, a review summarizing the authors' 35 years of experience stated that with sufficient dissection, long-lasting, stable results can be achieved with external suture fixation alone ^[1]. Neither article is a study that directly measured and compared how long results last; both are assessments based on literature summaries and the authors' experience, so it is difficult to judge which is correct.

In the scoping review, 74% of studies addressed patient satisfaction, but only 22% measured it in numbers, and follow-up ranged from 5.1 months to 4 years ^[3]. This means that data for comparing long-term results are still lacking, and how long results last can vary with the condition of each person's skin and muscles.

What to check during your consultation

A forehead lift is sometimes planned together with surgery around the eyes, so it is a good idea to sort out the extent and order of surgery in advance. Checking the following during your consultation can help.

• Examination findings on whether it is the brow or the eyelid that has drooped
• Which method is recommended, endoscopic or another approach, and why
• The fixation method to be used and its risks
• The likelihood of nerve-related complications and what recovery involves
• The order and plan if it is combined with eyelid surgery or other procedures