The endoscopic approach allows the surgeon to access the forehead using small incisions behind the hairline. An endoscope is introduced through three small incisions and used to lift up the tissues of the forehead and eyebrows, working under the skin and connective tissue layer of the forehead. The corrugator muscles between the eyebrows are teased apart, weakening them to relieve the frown lines. The attachments ("periosteum") holding the eyebrows down to the bony supraorbital rims are released. The deep forehead connective tissue layer ("galea") is then lifted upward, correcting the position of the brows. Tiny dissolving fasteners are used to hold the position of the elevated forehead until the tissues take hold in their new position. The sutures are inconspicuous, hidden behind the hairline. They are removed in about ten days. The hair is not shaved.
Even surgeons doing endoscopic forehead lifts use a variety of techniques. Some make as many as five incisions. However, with more incisions, the forehead lift starts to lose its minimal-scarring advantage. Surgeons use a variety of means of fixing the elevated forehead to the skull including:
- No fixation.
- Screws.
- Drilling a hole in the skull and putting a suture through it.
- Leaving a screw sticking out of the scalp for ten days or so.
- Temporary fastener.
I prefer the dissolving fastener approach using Bioplate® or LactoSorb® devices that are made out of a material similar to dissolvable sutures. The fasteners last long enough for the tissues to adhere to the underlying skull, and once their job is done, they go away. This way the patient does not feel any bumps later on.
