Endoscopic eyebrow lifting

Endoscopic eyebrow lifting is a minimally invasive surgical procedure that lifts drooping or sagging eyebrows, smooths forehead wrinkles, and rejuvenates the upper face.

It is difficult to accurately identify the inventor of the endoscopic eyebrow lift, but two surgeons are most often credited with its development and popularization:

Nicanor Isse: In 1994, Dr. Isse published the first detailed description of the endoscopic eyebrow lift technique in the medical literature. He is considered a pioneer of this procedure, laying the foundation for its improvement and widespread use.

Gregory Keller: Dr. Keller further popularized the endoscopic eyebrow lift in the late 1990s and early 2000s. He promoted the minimally invasive approach and refined the technique to achieve natural-looking results, making it accessible to a wider range of patients.

Many other doctors have contributed to the development of endoscopic eyebrow lifting over the years. Based on the initial work of Dr. Isse and Dr. Keller, various modifications and improvements have been made to enhance safety, effectiveness, and aesthetic outcomes.

Dr. Oscar Ramirez is also a key figure in the field. He significantly improved the technique, especially through:

• Development of innovative surgical instruments: Ramirez created specialized tools for this procedure, known as the Ramirez Endoscopic Eyebrow Lift Kit. These instruments provide greater precision and control during surgery.
• Advances in surgical technique: Ramirez published his approach, emphasizing minimally invasive techniques and natural-looking results through shorter incisions and faster recovery.
• Educational contribution: Ramirez actively teaches other surgeons through conferences and seminars, sharing his expertise and promoting safe and effective use of the procedure.

Although he did not invent the procedure, Dr. Ramirez remains a respected figure whose dedication has had a significant impact on its advancement.

The field of cosmetic surgery continues to evolve, and numerous surgeons have contributed to the development of endoscopic eyebrow lifting. Dr. Ramirez’s work stands out for improving the safety, accessibility, and outcomes of the procedure.

How the procedure works: Small incisions are made behind the hairline. A thin endoscope (a flexible tube with a camera) is inserted through one incision, allowing the surgeon to view internal forehead structures on a monitor. Using specialized tools, the tissues are lifted and the eyebrows are repositioned. Excess tissue is removed, and the incisions are closed.

Advantages: Compared to traditional lifting techniques, the endoscopic approach involves smaller incisions, less scarring, minimal bleeding, and faster recovery. The use of an endoscope improves visualization and accuracy.

Recovery: Patients can typically return home on the day of surgery. Most resume normal activities within 1–2 weeks. Swelling and bruising are expected but usually resolve within a few weeks.

Results:

• Provides a toned, youthful appearance to the upper face
• Long-lasting rejuvenating effects

Risks: Potential complications include infection, nerve damage, asymmetry, and visible scarring. As with any surgical procedure, a full discussion of risks with a qualified surgeon is essential.

Key statistics:

• Endoscopic temporal lift is the most common method (44.7%)
• Minimally invasive techniques dominate (78.7%)
• Effectively lifts both medial and lateral brows (approx. 1.8 cm)
• Offers improvement compared to other temporal lift techniques
• Affects all eyebrow zones, unlike many methods

Ideal eyebrow shape and position:

• For women: an arched shape with the peak near the outer eye corner
• For men: a straighter brow positioned at the supraorbital margin

Indications for eyebrow lifting:

• Obstructed visual field
• Pseudoblepharoptosis (appearance of droopy eyelids without muscle pathology)
• Eyebrow ptosis
• Facial paralysis
• Eyebrow asymmetry
• Forehead wrinkles
• Glabellar lines (frown lines)
• Aesthetic concerns such as a tired or angry appearance

Direct lifting is preferred in cases of:

• Absence of forehead wrinkles
• Unilateral facial paralysis
• Prominent forehead (limits endoscopic access)
• Receding hairline or baldness
• Heavy eyebrows
• Existing eyebrow scars
• Patient preference

Direct lifting is more commonly used for reconstructive rather than aesthetic purposes.

Contraindications:

• Body dysmorphic disorder
• Previous blepharoplasty (relative contraindication)
• Dry eye syndrome or reduced tear production

Contraindications for direct lifting:

• Reluctance to accept visible facial scars
• Thin eyebrows
• Anatomy or expectations better suited to a different approach

Required equipment:

Preoperative:

• Surgical marker
• Local anesthetic injections
• Antiseptic skin prep
• Eye protection (corneal shield or eye sticker)

Intraoperative:

• Scalpel
• Soft tissue surgery instruments
• Electrocautery device
• Sutures (e.g., 4-0 Monocryl for deeper layers, 6-0 Prolene for skin)

Postoperative:

• Antibiotic ointment
• External dressing (surgeon’s preference)

Surgical team:

• Facial plastic surgeon
• Surgical technician
• Scrub nurse
• Anesthesiologist and/or anesthetic nurse