A Comparison of Brow Elevation and Complications: Endoscopic Versus Pretrichial Brow Lift.

Abstract

Browlift is a common procedure to treat brow ptosis and provides lasting esthetic results with minimal morbidity. This study aimed to investigate long-term retention of brow elevation and complication rates following endoscopic versus pretrichial browlift. A retrospective chart review was conducted to collect demographic, intraoperative, and postoperative complication data on patients who underwent endoscopic or pretrichial browlift between May 2019 and February 2024 at a tertiary care institution. ImageJ Software was used for photographic assessment to calculate preoperative and postoperative brow height ratios. Fifty patients underwent endoscopic browlift; 22 underwent pretrichial browlift. There was no significant difference in the incidence of postoperative ecchymosis, erythema, numbness, hematoma, seroma, brow weakness, scarring, or alopecia between the cohorts (p > 0.05). Percent change in brow height ratio at the first postoperative visit was greater in the endoscopic (21%) versus pretrichial group (13%) (p < 0.01). Of 72 patients, 45 had follow-up beyond 6 months (mean 429 days, range 180-984). In this subgroup, mean brow elevation ratios were 1.4 for endoscopic and 1.3 for pretrichial brow lifts, with a percent change (-2.6% vs. -2.9%) indicating no significant difference between groups from the prior visit (p > 0.05). Multivariate analysis revealed that technique was not a significant predictor of long-term brow height (p > 0.05). While both browlift techniques provide adequate brow elevation, the endoscopic technique results in significantly greater elevation in the immediate postoperative period. Given similar long-term brow height retention and complication rates in both groups, factors such as hairline position and forehead length should guide the technique used.