Options in upper face rejuvenation

Deciding between techniques available for upper face rejuvenation can be difficult. Options include eyelid surgery (belpharoplasty), forehead lifting and the more comprehensive extended subperiosteal lift. This article will focus on choosing between the later two options. Readers can learn more about all of these techniques in other sections of our website. Our search engine will help you find appropriate areas.

Both the subperiosteal lift and the endoscopic brow lift are operations designed to lift the forehead and brow, but beyond that, there are major differences between the techniques.

Endoscopic Brow Lift

The endoscopic brow lift is a modern technique that evolved from the older traditional coronal or forehead lift. Instead of using an incision across the top of the head, as series of small incisions are made just above the hair line, with an additional small incision at the top of the head. These incisions vary from less than a half to one inch in length. Using lighted telescopes and a small video camera, the forehad, temple and brow tissue is separated from the underlying bone, elevated upward and backward, and fixed by sutures that hold the tissue in place. The primary effect is to raise and stabilize the brow and minimizing forhead wrinkling and sagging. There is also some elevation of the temple tissues and very slight elevation of the corner of the eye.

Extended Subperiosteal Coronal Lift

The subperiosteal lift also developed from the older coronal lift, but in this case, the development was in a different direction. Instead of moving in a more conservative direction, this operation takes a more aggressive approach involving downward dissection into the mid and upper face. Not only is the brow and forehead elevated and supported, but also the soft tissue of the mid face is addressed. There is even some improvement down to the jaw line. There is distinct improvement around the corner of the eye and over the cheekbone area.

The advantage of the endoscopic operation is primarily related to the low risk of complications, and the fact that recovery is usually prompt. The subperiosteal lift, on the other hand can result on longer recovery. While experience has reduced the risk of complications with this operation, there still does remain some added risk of nerve damage that can cause weakness of the forehead muscles.

How to Make a Decision

Certainly, each patient is different and no hard and fast rules can be given. Patients seeking the most effect in the mid and upper face will generally opt for the subperiosteal approach. Interestingly, our experience indicates that about half our patients opt for each approach. We have noticed that when upper lifting is combined with the traditional lower facelift, the combination of the subperiosteal lift with the lower lift can result in significant swelling. In contrast, combining and endoscopic brow lift with a lower lift seems to add little or no added recovery. For this reason, primarily, patients who are combining upper and lower lifting are more likely to select the endoscopic approach, while those who are treating the upper face alone tend to prefer the subperiosteal lift.

As always, the best decision is made by careful study of the options along with a detailed personal consultation. We hope that this information will at least answer some of the questions related to choosing between these options.