Endoscopic Forehead Lift

Overview

Endotine forehead operations, when performed by a board-certified plastic surgeon, produce natural results that can endure for years, not just months.

Endotine forehead operations have been documented using a variety of approaches. When compared to the coronal technique, small-incision endoscopic brow lift treatments are often preferred due to the lack of facial scarring, quicker wound healing, and less concerns with postoperative alopecia or sensory loss.

The Endotine forehead device (Coapt Systems, Palo Alto, CA, USA) is a recently invented bioabsorbable device that was authorized by the US Food and Drug Administration in March 2002 for use in brow and forehead lift surgery. It was created to give a balanced distribution of strain in order to avoid tissue deformation, which can lead to fixation failure and forehead redescence.

When compared to single-point fixation, its design is designed to lessen stress on the incision, hence minimizing damage to surrounding hair follicles and maximizing fixing strength. One year after fixing, the gadget is totally absorbed.

Endotine Implants

Endotine implants are used in a variety of facial procedures including browlifts, cheeklifts and necklifts, to suspend and anchor your lifted soft tissue.

  • Forehead Lift:

A surgical forehead lift corrects sagging brows and softens anxious or angry faces caused by frown lines and crow’s feet.

Endotine allows doctors to alter the position of your forehead skin using extremely small incisions beneath your hairline, elevating your brows to their natural position and flattening wrinkles between your brows and along your forehead.

This treatment normally takes between one and two hours and is conducted under intravenous sedation or general anesthesia in the surgeon’s office or an outpatient surgery center.

  • Cheek lift:

Endotine allows doctors to effortlessly restore drooping cheek volume by retaining your skin until it naturally stays in its new raised, youthful posture.

The midface is defined as the space between your lower eyelids and your lips. Gravity, frequent muscular contraction, lifestyle, and genetics all cause the skin, fat, and muscle in this area to go downwards as you age.

This makes the cheeks look droopy or flat, the lower eyelids puffy or hollow, circles emerge beneath the eyes, and the lines between the nose and the corner of the mouth deepen.

  • Neck lift:

Endotine neck lift implants are used to rejuvenate the lower face, including the neck and jowls. Endotine retains your skin in its new raised, youthful state until it naturally maintains it.

The Endotine neck lift implant is a thin flexible strip of plant-based bio-absorbable material that allows your surgeon to precisely place your neck or jowl profile. The device then dissolves and is spontaneously absorbed when the relocated tissue bonds completely in its new place. 

Your surgeon will normally create a tiny, usually invisible incision in the hairline or behind the ear for an endoscopic, minimally invasive neck lift.

For a conventional, open neck lift, your surgeon will typically make an incision beginning above the hairline near the temples, extending in a natural line across the front of the ear and then behind the earlobe.

Why Forehead Wrinkles?

Wrinkles are a common, normal sign of aging. They’re caused both by natural factors and by a range of environmental factors, some of which you may be able to control. Common causes of wrinkles include:

  1. Getting older. Not surprisingly, forehead wrinkles and other signs of skin aging tend to become more common as you age and your skin becomes less elastic. This is because your skin produces less collagen, an important structural protein found in connective tissue, over time. Research indicates that collagen levels in skin drop at a rate of about one percent every year.
  2. Sun exposure. Spending time in the sun without protection can expose your skin to UV radiation, a major cause of premature signs of aging. Excess sun exposure also increases your risk of developing skin cancer.
  3. Smoking. Smoking is linked to a reduction in collagen synthesis, with one study finding that tobacco smokers produce certain types of collagen at a lower rate than non-smokers.
  4. Genetics. Just like other aspects of your appearance, your genetics may play a role in your likelihood of developing forehead wrinkles. 

Other factors that may cause forehead wrinkles to develop include alcohol consumption, poor sleep habits, and excessive use of your facial muscles.

For example, certain facial expressions, such as smiling, raising your eyebrows, and squinting, all require the use of your facial muscles. Over time, these expressions can cause grooves to develop in your skin that eventually becomes wrinkles.

Contrary to popular belief, wrinkles don’t suddenly show up in your skin as you begin your 30s, 40s, 50s, or sixties. Instead, wrinkles usually develop slowly over time, only becoming visible once they’re deep and pronounced enough for you to notice.

If you’re worried about wrinkles, it’s important to pay attention to your skin. Try to look for signs of wrinkles in your forehead and elsewhere on your face. 

When it's Recommended?

This procedure is most often done on people in their 40s to 60s to slow the effects of aging. It can also help people with inherited conditions, such as furrowed lines above the nose or a droopy eyebrow.

In younger people, a forehead lift can raise low eyebrows that give the face a “sad” look. The procedure can also be done in people whose brows are so low that they block the upper part of their field of vision.

A good candidate for a forehead lift has one or more of the following:

  • Deep furrows between the eyes
  • Horizontal wrinkles on the forehead
  • Sagging brows
  • Tissue that hangs down at the outer part of the eyelids
  • Problem seeing because of the hanging tissue

Who's a Candidate?

You may be a candidate for brow lift surgery if you:

  • Are physically healthy
  • Nonsmoker
  • Have a positive outlook and realistic goals

As we age, we may develop unwanted wrinkle lines on the forehead. Frown lines between the brows might create the impression that we are angry or “overly serious.” Skin relaxation may cause our brows to droop, hooding our upper eyelids and giving us a tired expression. If these signs of aging in the brow area concern you, a brow lift may be the solution.

When it's Not Recommended?

Poor medical health such those with poor controlled diabetes, hypertension, uncompensated heart or pulmonary disease, people who take blood-thinning drugs on a regular basis, patients with excessive expectations, and heavy smokers are all relative contraindications.

Fine wrinkles which may be controlled by nonsurgical or conservative therapy very effectively are contraindications of facelift surgery. Secondary facelifts should be performed with caution as well, because the scar from the previous treatment may alter the original tissue planes, increasing the risk of facial nerve injury.

How to Prepare For the Procedure?

Before undertaking the forehead implant treatment, there are various factors to consider. It may contain the following items:

  1. Informing the surgeon about your current health situation. This might include your prior medical history, your current health condition, prescribed medicines, and, if applicable, dietary or drug allergies.
  2. With a highly qualified and experienced plastic surgeon, discuss the surgical aims, any existing medical conditions, risks, probable consequences, and treatments.
  3. If you are at high risk of immune deficiency and medical issues, you must say this. It’s possible that health issues are interfering with the healing process and causing infection. This aids in the avoidance of major problems during or after the treatment.
  4. If you are using blood thinners or any other medicine that may impact blood coagulation, your doctor should be aware.
  5. You should avoid consuming supplements and vitamins for a few days or hours before the surgery. Vitamin E, ginseng extract, grapeseed oil, and fish oil are all examples. It would also be beneficial if you avoided them for at least one month following the therapy.
  6. Avoid consuming alcohol and other drugs for 1 to 2 days before and 5 to 7 days after surgery.
  7. It is also critical to refrain from smoking for at least two weeks before and after the procedure. This is due to the presence of compounds in cigarettes that may affect the amount of oxygen in the blood. As a result, infections and a delayed healing process occur.
  8. Avoid using aspirin, anti-inflammatory medications, and herbal supplements for at least two weeks since they might increase bleeding and bruising.
  9. Avoid eating and drinking for at least 6 hours before surgery.
  10. Ensure that you thoroughly wash your hair before undergoing surgery.
  11. Ensure that there is no makeup, contact lens, polish, and other accessories that might interfere with the procedure. 
  12. If you are 45 years of age and above, you may be required to undergo a complete health examination before the procedure. This is essential to prevent various risks associated with age. 

Forehead Lift Procedures

1. Endotine Forehead-mini

The Forehead-mini provides the security and predictability of Endotine multipoint fixation to patients who are not currently candidates because of concerns with palpability, visibility, sensitivity or prolonged absorption.

Advantages: 

  • Fewer Tines. Three 3.0mm tines and an ultra-thin platform offer security without sensitivity for patients who may be affected by palpability. 
  • Low Profile Fixation. Forehead-mini has an ultra-thin platform that is 60% smaller than the Endotine Forehead. With a low profile for reduced visibility and a petite size for a sub-10mm incision, the Forehead-mini is ideally suited for patients with below-average scalp thickness. 
  • Reduced visibility and incision size allow the Forehead-mini to be placed confidently below the hairline.
  • With one-third the mass of an Endotine Forehead, the Forehead-mini will absorb quicker to an impalpable size, greatly enhancing the patient’s post-operative experience.

Procedure:

  • Make the Incision: Make a sagittal, paramedian incision in the usual fashion. Perform the dissection, making sure to achieve adequate release.
  • Drill the Hole: An anchoring hole for the Endotine Forehead-mini is drilled in the frontal bone using the enclosed drill bit. Drill all the way to the bit sleeve. Suction the hole to remove all debris.
  • Place the Device: The implant is inserted into the hole until the platform lays flush against the frontal bone.
  • Withdraw the Tool: The implant is released from the insertion tool via counter-clockwise turn of the insertion tool.
  • Elevate the Tissue:  Elevate brow tissue to desired position. The implant may lie either anterior or lateral to the incision
  • Secure the Tissue: Apply digital pressure to ensure penetration of the tissue by the device tines. Close the incision. A gentle pressure dressing is recommended to prevent dislodgement.

 

2. Endotine TransBleph

Bleph and Brow, an unstoppable combination in a single surgical procedure, you may now achieve the combined aims of removing upper eyelid skin and relocating the brow. The Endotine TransBleph simplifies the brow lift operation by employing the upper blepharoplasty incision for access. There is no need for pricey endoscopic equipment, which means fewer instruments to set up, process, and maintain. 

The Endotine TransBleph combines the best of both worlds in rejuvenation surgery: pioneering fixation of multipoint, bioabsorbable implants and the capacity to execute two successful operations through a single incision—all without the need for general anesthetic or expensive equipment.

Procedure:

  • Make the Incision: The supraorbital rim is approached subperiosteally through an upper blepharoplasty incision. The brow is released to create adequate mobility
  • Drill the Hole: An anchoring hole for the Endotine TransBleph is drilled in the frontal bone using the enclosed drill bit. Drill all the way to the bit sleeve. Suction the hole to remove all debris.
  • Place the Device:The implant is inserted into the hole until the platform lays flush against the frontal bone.
  • Release the Device: The implant is released from the insertion tool via counter-clockwise turn of the insertion tool.
  • Two Fixation Points: 1. Elevate the periosteum to achieve the desired brow height. Use digital pressure to engage the tissue. 2. Elevate the edge of the periosteum up and over the tines for maximum lift.
  • Closure: The incision is closed with standard technique and a compression bandage is applied.

What happens after the Procedure?

  1. Pain that is readily controlled by medicine usually subsides in a day or two after surgery.
  2. For three to four weeks, avoid heavy activities.
  3. Throughout the first few days after recuperation, apply cold compresses to your forehead for 20 minutes at a time to reduce swelling and discomfort.
  4. To decrease postoperative swelling, keep the head elevated for 1-2 weeks after surgery.
  5. Forehead firmness may persist for several weeks after surgery.
  6. Swelling, bruising, or systemic problems on the forehead, upper eyelids, or under the eyes may occur after surgery. These symptoms may appear in varying degrees depending on the individual. The majority of the time, the symptoms will go away within 2-4 weeks.
  7. Following the operation, the nurse will put a headband over the patient’s head, which must be wrapped approximately 3 days following surgery.
  8. After surgery, patients can wash their faces normally, but they must be careful not to get the surgical wound wet with water for the first three days. After three days, the patient can gently wash his or her hair.
  9. It is advisable to apply a cold compress to the forehead and eyes for 24 hours over the first three days to alleviate the swelling. If the edema persists, the patient should continue to apply cold compresses to the affected area. Typically, the edema will subside over 2-4 weeks.
  10. When sleeping, it is recommended that the head be lifted high. It is preferable if you can sleep in a semi-lying, semi-sitting position, but if you are unable to sleep, it is recommended that you place 2-3 pillows to support your head. This will aid in the reduction of bruising.
  11. To avoid irritating the scalp, keep a range of button-up shirts on hand during recovery.
  12. To reduce swelling, we will give you a compression garment that you should wear as much as possible for at least two weeks.

Risk & Complications

When performed by a highly qualified and experienced cosmetic surgeon, forehead augmentation is associated with extremely few issues. Potential hazards include:

  • Implant shifting, which might require another procedure to reposition 
  • Formation of blood clots such as deep vein thrombosis 
  • Acute to chronic pain 
  • Poor healing of the wound 
  • Numbness or changes in sensation around the forehead and scalp 
  • Damages of the blood vessels, nerves, muscles, teeth, or gum 
  • Unfavorable scarring on the hairline 
  • Uneven firmness or contours on the implant 
  • Hematoma
  • Asymmetry on the forehead 
  • Infection of the incision area

Fortunately, these dangers are modest and easily avoided. Furthermore, you can fully recover in 5 to 10 days and resume your usual daily activities. Bruising and swelling around the eyelids may occur throughout the healing process. Although this may not be a significant problem, the surgeon may advise removing the sutures to alleviate the pain.

Conclusion

Soft tissue fixation remains the least controllable and least predictable part of the forehead lift procedure. Until now, only suture-based and percutaneous screw fixation techniques were available, often with frustrating results. The Endotine devices deliver a novel and effective solution for fixation of the scalp tissue, addressing the primary challenge of the forehead lift procedure.

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