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The endoscopic brow lift aims to restore a more youthful and rested appearance to the upper third of the face. This activity reviews the evaluation of brow ptosis and the technical aspects of endoscopic brow lifting and describes the role of the interprofessional team in improving care for patients undergoing endoscopic brow lifting. Objectives: Identify the anatomical structures involved in an endoscopic brow lift. Describe the equipment, personnel, preparation, and technique of endoscopic brow lifting. Identify the potential complications associated with performing an endoscopic brow lift. Coordinate with the interprofessional team to improve care and patient outcomes. Access free multiple choice questions on this topic.

Descent of the brows plays a fundamental role in facial aging. During the aging process, the brow becomes ptotic, which may cause lateral upper eyelid hooding with or without visual field deficits. Moreover, patients with these characteristic signs of aging are often perceived by others as appearing fatigued or angry, despite being well-rested and in a good mood.[1] Currently, several well-described surgical methods exist for improving brow aesthetics, ranging from traditional open approaches to newer endoscopic techniques. While each method has its associated benefits and limitations, there is no clear evidence to indicate which type of brow lift surgery is superior.[2][3] The endoscopic brow lift was first described in the literature by Nicanor Isse in 1994, and since then, it has evolved both in technique and popularity.[4] More than half of brow rejuvenation procedures performed today are endoscopic, which likely reflects the current trend toward minimally invasive cosmetic surgery.[5] Therefore, the modern aesthetic surgeon should thoroughly understand endoscopic brow lifting, a technique used to produce reliable and lasting brow restoration.[6][7]

The most common complications of the endoscopic brow lift are paresthesia/dysesthesia, asymmetry, alopecia, lagophthalmos, and the need for revision. Motor nerve injury to the frontal branch of the facial nerve, a complication feared the most, is less common. Fortunately, temporary paresis is far more common than permanent paralysis. Other complications include edema, wound dehiscence, eye problems, glabellar irregularity, granuloma, hematoma, infection, pain, palpability of implanted materials (eg, screws or tines), pruritus, screw exposure, seroma, skin burn, and scar formation.[15][2] Patient satisfaction with endoscopic brow lift is high (greater than 98%), and reports of significant complications are rare.[5] Lastly, while the endoscopic brow lift may have a lower complication profile compared to traditional open approaches, open approaches still provide a more effective or durable lift. There is very little available data on the subject.[16]

It is essential to identify the risk factors and conduct a thorough assessment of the patient before performing an endoscopic brow lift. A team approach is an ideal way to minimize the complications associated with this procedure. Before surgery, the patient should have the following evaluations: Evaluation by a surgeon experienced in selecting the appropriate patient for the surgery Evaluation by the primary care physician and anesthesiologist or nurse anesthetist to ensure that the patient is fit for general anesthesia Evaluation by the optometrist or ophthalmologist if the patient suffers from dry eyes, blepharoptosis, or lagophthalmos Evaluation and monitoring by the preoperative, intraoperative, and postoperative specialty nurses to assist with the coordination of care and patient and family education An interprofessional team comprising a surgeon, an anesthesiologist, surgical assistants, and operating nurses should perform the endoscopic brow lift to ensure optimal outcomes. A nurse dedicated to the monitoring of the patient during anesthesia is highly recommended. Pharmacist involvement includes verifying the selection and dosing of prophylactic antibiotics preoperatively to ensure appropriateness. Postoperatively, pharmacists contribute by recommending pain management strategies, optimizing corticosteroid dosing, and performing thorough medication reconciliation to prevent drug-drug interactions. During the initial postoperative period, close follow-up by a wound care nurse or a clinician experienced in endoscopic brow lift recovery is essential to monitor for complications such as hematoma formation. Patient education should emphasize the importance of avoiding strenuous activity, heavy lifting, and bending over in the first several days to minimize risk. Consistently optimizing outcomes for this procedure requires a coordinated, interprofessional approach to healthcare.

Adequate pain medication is critical, as patients often report severe tension headache-like discomfort for the first day or two postoperatively. Ice packs should be placed intermittently around the eyes for the initial 24 hours after surgery. The head dressing is removed on postoperative day 1, at which time showering may resume. Sleeping with the head elevated for one week, avoiding vigorous activity for two weeks after surgery, and a low-dose corticosteroid taper may help lessen bruising and swelling. Patients are asked to return in 1 week for a wound assessment and staple or suture removal. Hair coloring is safe to perform at one month. It is not uncommon for the tine-fixation devices to remain palpable for 5 months or longer. Photographic documentation should occur at the 3-month and 12-month visits.