Endoscopic Gliding Forehead Lift for Balanced Medial and Lateral Brow Lift
- Admin
- 2 hours ago
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Brow aesthetics play a pivotal role in facial rejuvenation, particularly in patients seeking a harmonious balance between the medial and lateral brow. Traditional browlift methods, including lateral-focused gliding browlifts, often fail to address the nuanced needs of patients—especially in Asian populations—where achieving both medial and lateral brow elevation is critical for natural-looking results.
The endoscopic gliding forehead lift, recently detailed by Wongkietkachorn & Wongkietkachorn (2025), offers a minimally invasive, precision-focused approach that allows surgeons to shape and lift the brow with enhanced control. Below, we break down the technique, highlight practical surgical considerations, and share key takeaways for direct clinical application.
Why the Endoscopic Gliding Forehead Lift?
While lateral brow elevation is often the focus of traditional gliding browlifts, this approach can inadvertently create overly upslanted brows or an “angry” appearance in patients with naturally upslanted eyes. Conversely, lifting predominantly medially may result in a surprised look. The endoscopic gliding forehead lift addresses both concerns by:
Allowing customized brow shaping for both medial and lateral aspects.
Preserving the frontalis muscle, reducing the risk of abnormal brow movement.
Minimizing incision length and avoiding temporal scars, which improves postoperative aesthetics.
Mechanisms Behind the Gliding Brow Technique
The gliding eyebrow method achieves outcomes that traditional browlifts often cannot due to several key anatomical and mechanical mechanisms:
Subcutaneous Mobility
By performing subcutaneous dissection, the brow and overlying skin are mobilized as a continuous layer.
This allows precise repositioning in multiple directions, rather than lifting a single point as in traditional lateral or medial-only lifts.
Dual-Plane Strategy
Two planes are created: a superior subcutaneous plane and an inferior deep plane.
Connecting these planes allows the brow to glide naturally into the desired position, distributing tension evenly and reducing focal stress on the skin or muscle.
Frontalis Preservation
Sharp dissection under endoscopic guidance protects the frontalis muscle.
Preserving muscle function ensures natural eyebrow movement, avoiding the stiff or “frozen” appearance sometimes seen with traditional techniques.
Hemostatic Net Fixation
The hemostatic net provides multiple fixation points, stabilizing the brow in the intended position.
This prevents drift during the early healing phase, which is a common limitation in traditional single-suture or anchor methods.
Skin Redistribution
Excess forehead skin is redistributed into the hair-bearing area, rather than excised excessively.
This prevents temporal scarring, hairline distortion, or tension lines, challenges frequently encountered in traditional subcutaneous or direct excision lifts.
Together, these mechanisms allow the gliding brow technique to customize brow shape, correct asymmetry, and achieve both medial and lateral elevation—results that are difficult to achieve with conventional browlift methods.
Step-by-Step Technique Overview
Preoperative Planning
Assess brow position in the upright position and simulate the desired lift manually.
Measure brow-to-pupil distance (BPD), brow-to-lateral canthus distance (BLCD), and brow-to-medial canthus distance (BMCD).
Identify asymmetries and document the desired lifting vector.
Incision and Dissection
Central forehead incision: ~3 cm along the anterior hairline.
Sideburn incision: ~2.5 cm, hidden within hair.
Tumescent infiltration and local anesthesia.
Introduce endoscope and perform sharp subcutaneous dissection, preserving the frontalis muscle.
Temporal Plane Creation
Sideburn incision provides access to the superficial temporal fascia.
Dissection beneath this layer minimizes hair loss and avoids visible scarring.
Two planes are created:
Superior plane: subcutaneous, anterior to hairline.
Inferior plane: deep layer, posterior to hairline.
Connecting Planes and Skin Mobilization
Use LigaSure device to cut the superficial temporal fascia and connect planes.
Redistribute skin into the hair-bearing area to prevent temporal incisions.
Brow Shaping and Fixation
Start with the lower side of the brow, then adjust the higher side for symmetry.
Fix with 3-0 non-absorbable sutures for seven days.
Stabilize surrounding tissue with a hemostatic net using 5-0 non-absorbable sutures for two days.
Postoperative Care
Gauze and bandages for two days; remove hemostatic net on day three.
Sutures removed at one week.
Avoid sunlight for two months; hemostatic net markings resolve naturally.
Outcomes and Practical Insights
In a cohort of 100 patients (200 brows):
BPD increased from 19.0 mm to 24.0 mm.
BLCD increased from 21.0 mm to 28.0 mm.
BMCD increased from 18.0 mm to 21.0 mm.
No hematomas or frontal branch facial nerve palsy were reported.
Clinical scenarios illustrate the versatility of the technique:
Balanced medial and lateral lift without changing brow shape.
Lateral-dominant lift while maintaining medial support.
Transforming horizontal brows to a more oblique and curved contour.
Correcting asymmetry with steeply angled brows for a more harmonious appearance.
These outcomes demonstrate the method’s ability to customize brow position and shape, rather than merely achieving maximum lift.
Benefits & Limitations of the Endoscopic Gliding Forehead Lift
Benefits
Customizable Brow Shape – Allows tailored lifting of both medial and lateral brows to achieve natural symmetry.
Minimally Invasive – Shorter incisions (central hairline 3 cm, sideburn 2.5 cm) reduce scarring and recovery time.
Frontalis Preservation – Sharp dissection under endoscopic guidance protects the frontalis muscle and avoids abnormal brow movement.
Improved Skin Redistribution – Mobilization of forehead skin into the hair-bearing region prevents temporal scarring and hairline distortion.
Predictable Stability – Hemostatic net and sutures provide controlled fixation for precise brow positioning.
Limitations
Endoscopic Equipment Required – Without an endoscope, larger incisions are needed for visualization, which increases invasiveness.
Not Designed for Maximum Lift – The goal is natural brow positioning rather than extreme elevation.
Learning Curve – Surgeons unfamiliar with the gliding browlift technique may require additional training for safe and effective outcomes.
Limited Effect on Forehead Rhytides – While some improvement occurs, deeper wrinkles may require adjunctive treatments.
When to Use the Endoscopic Gliding Forehead Lift
Balanced medial and lateral brow ptosis requiring symmetric elevation.
Patients with naturally upslanted eyes where lateral-only lift may create an aggressive look.
Horizontal or flat brows needing oblique or curved contouring.
Asymmetrical brows with uneven height or angle.
Patients concerned about scarring or who prefer minimally invasive approaches.
Cases requiring precise customization of brow shape, often in combination with facelifts or facial rejuvenation procedures.
Patient Selection: Who is Suitable?
Ideal Candidates:
Patients seeking balanced medial and lateral brow elevation.
Asian patients or others with naturally upslanted eyes.
Patients preferring minimal scarring and faster recovery.
Patients with mild to moderate brow ptosis or asymmetry.
Not Suitable:
Patients requiring maximum brow elevation.
Individuals with prior brow or forehead surgeries, illegal filler injections, or extensive scar tissue.
Patients unable to comply with postoperative care requirements.
Key Takeaways for Clinical Practice
Patient-Specific Planning is Crucial: Brow shape and vector should be individualized based on preoperative anatomy and aesthetic goals.
Minimally Invasive Dissection Preserves Function: Endoscopic visualization and sharp dissection protect the frontalis muscle.
Two-Plane Approach Enhances Control: Superior and inferior planes allow safe and precise skin and brow mobilization.
Hemostatic Net Enables Stable Fixation: Multiple fixation points help maintain the desired brow position and symmetry.
Avoiding Temporal Incisions Reduces Scarring: Strategic redistribution of skin prevents additional visible wounds.
Conclusion
The endoscopic gliding forehead lift is a safe, customizable, and minimally invasive solution for shaping and lifting both the medial and lateral brows. It is particularly indicated for patients with asymmetry, ptosis, horizontal brows, or naturally upslanted eyes, and for those who prioritize natural results and minimal scarring. Understanding the indications, benefits, limitations, and patient selection ensures surgeons can achieve predictable, aesthetically pleasing outcomes in their practice.
Reference:
Wongkietkachorn, A., Wongkietkachorn, N. Endoscopic Gliding Forehead Lift: A Brow Shaping Method to Lift the Medial and Lateral Brow. Aesth Plast Surg (2025). https://doi.org/10.1007/s00266-025-05027-z
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