Hello,

I am Dr. Yang Seong-hyeok, a board-certified plastic surgeon at Hugo Plastic Surgery, 

where we specialize in facial rejuvenation.

When discussing forehead lift surgery with patients, I am often asked:

“How is an endoscopic forehead lift different from a traditional forehead lift?”

“Where is the endoscope inserted?”

“If the incisions are small, how is the tissue actually lifted?”

As the name suggests, an endoscopic forehead lift is a surgical procedure that uses an endoscope to visualize the forehead and brow area. The tissues are carefully released, repositioned, and secured to achieve the desired brow position.

However, Small incisions are only one part of the procedure behind an endoscopic forehead lift.

What matters most is accurately identifying the anatomical structures that affect brow and forehead movement, releasing the tissues that restrict movement, and then repositioning and securing them in place in the desired position.

Today, I will walk you through each step of an endoscopic forehead lift and explain why each stage is important.

What Is an Endoscopic Forehead Lift?

First, the endoscope itself is not the purpose of the surgery.

An endoscope is a device equipped with a camera that is inserted through a small incision, allowing the surgeon to view the surgical area with magnification.

During an endoscopic forehead lift, several small incisions are made in the scalp. Through these incisions, the endoscope provides a magnified view of the anatomical structures of the forehead and brow.

The surgeon then releases tissues that are tethered to or attached to surrounding structures, allowing the forehead and brow tissues to move freely into the desired position.

Who May Be a Candidate for an Endoscopic Forehead Lift?

An endoscopic forehead lift may be considered for patients whose brows have descended, making the upper eyelids appear heavy, or for those 

who wish to improve the position of both the forehead and brows.

■ In particular, the procedure may be considered for patients who:

■ Have drooping brows that make the eyes appear heavy or tired.

■ Have upper eyelids that appear hooded due to brow descent.

■ Have age-related changes affecting both the forehead and brows.

■ Wish to improve the position or shape of their eyebrows.

■ Have forehead wrinkles and brow ptosis that should be evaluated together.

How Is an Endoscopic Forehead Lift Performed?

An endoscopic forehead lift can be divided into the following main stages:

Preoperative planning → Incisions → Endoscope insertion and tissue dissection 

→ Tissue release and, when necessary, muscle modification → Tissue repositioning → Fixation → Wound closure

Each stage serves an important purpose.

1. Preoperative Planning | It Is Not Just About How High to Lift, but Where to Position the Brows

Before surgery, the surgeon evaluates the forehead height, hairline, brow position and asymmetry, upper eyelid drooping, and forehead wrinkles.

The goal is not simply to raise the eyebrows, but to plan a brow position and shape that harmonize with the patient's overall facial features.

2. Small Scalp Incisions Are Made, and the Endoscope Is Inserted

Small incisions are made in the scalp behind the hairline, and the endoscope is inserted through one of these openings.

The surgeon views the surgical area on a monitor, using the magnified image to identify the anatomical structures of the forehead and brow and to guide the procedure.

3. The Forehead and Brow Tissues Are Dissected

Simply pulling the skin is not sufficient to reposition a drooping brow.

The tissues must be dissected along the appropriate anatomical plane so that they can move freely. Surrounding tissues that restrict movement are released as needed, within the appropriate anatomical boundaries.

This allows the forehead and brow tissues to be repositioned without excessive tension.

4. Structures That Pull the Brows Downward Are Adjusted, and the Tissues Are Repositioned

Brow position is influenced by the balance between muscles that elevate the brows and those that pull them downward.

When indicated, the action of muscles that depress the brows may be adjusted. Once the tissues of the forehead and brow have been adequately released, they are moved into the planned position.

The key is not simply to raise the brows as high as possible, but to achieve a natural position that takes into account brow shape and overall facial balance.

5. The Sagging Tissues Are Repositioned

Once adequate tissue release has been achieved, the forehead and brow tissues are moved into the planned position.

The important consideration is not how high the tissues can be lifted, but how to position them in a way that complements the patient's brow shape and overall facial proportions.

6. The Sagging Tissues Are Repositioned

After sufficient dissection, the forehead and brow tissues are moved into the intended position. The goal is to achieve a natural result that takes into account the shape of the eyebrows and the balance of the entire face, rather than simply lifting the brows as high as possible.

7. The Repositioned Tissues Are Secured, and the Incisions Are Closed

Once the tissues have been repositioned, they are secured to help maintain the intended position during healing. The incisions are then closed.

The fixation method may vary depending on the patient's tissue condition and the extent of the surgery.

Options may include bone-tunneling fixation using sutures or dual fixation using Endotine. The appropriate method is selected according to the individual patient's needs.

What Changes Can Be Expected After an Endoscopic Forehead Lift?

Immediately after surgery, the eyebrows may appear higher than usual, and patients may experience a sensation of tightness across the forehead.

Temporary changes in sensation, such as numbness or tingling in the forehead and scalp, may also occur. Swelling and bruising can sometimes extend to the area around the eyes.

These changes can occur during the postoperative recovery period. Since recovery varies considerably from person to person, it is important to monitor the gradual reduction in swelling and stabilization of the tissues rather than judging the outcome based on a specific postoperative day.

If unexpected symptoms occur, such as suddenly worsening pain or swelling, bleeding, or changes in vision, patients should contact their surgeon for evaluation.

What Is the Difference Between an Endoscopic Forehead Lift and Upper Blepharoplasty?

Both an endoscopic forehead lift and upper blepharoplasty can address concerns around the eyes. However, they differ in the anatomical areas they target and their primary surgical goals.

An endoscopic forehead lift focuses on the forehead and brows. It repositions drooping brows and upper facial tissues upward to help improve a heavy or tired appearance around the eyes. The procedure is generally performed through small incisions in the scalp.

In contrast, upper blepharoplasty directly addresses excess skin and tissue of the upper eyelids. The procedure typically involves an incision near the upper eyelid crease to remove or adjust excess skin and, when appropriate, other tissue.

It may be considered when excess upper eyelid skin is the primary cause of the patient's concerns.

Therefore, even when patients share the same concern—that their eyes look heavy or feel obstructed—the appropriate surgical approach may differ depending on whether the primary cause is brow ptosis or excess upper eyelid skin.

The key is to evaluate not only the eyelids themselves, but also the relationship between the forehead, brows, and upper eyelids before determining the most appropriate treatment.

In an Endoscopic Forehead Lift, What Matters More Than the Endoscope Itself?

During consultations, I am sometimes asked:

“Does using an endoscope automatically make the procedure better?”

The endoscope itself does not determine the surgical outcome.

It is a tool that provides visualization of the surgical field. The outcome is influenced by several factors, including the areas and planes of dissection, how the structures that pull the brows downward are addressed, how far the tissues are repositioned, and which fixation method is used.

Because an endoscopic forehead lift involves working across a relatively broad area through small incisions, the surgeon must have a thorough understanding of the relevant anatomy.

In other words, using an endoscope is one aspect of the surgical technique; how the procedure is performed is what matters most.

A forehead lift is not simply a procedure to change the position of the eyebrows. It requires careful consideration of the balance between the brows, forehead, eyelids, and overall appearance of the eyes.

Before deciding on surgery, patients should have a thorough consultation to discuss the underlying cause of their brow ptosis, the most appropriate surgical approach, incision placement, the extent of dissection, the fixation method, and the expected recovery process.

A natural-looking forehead lift begins not with lifting the brows as high as possible, but with finding the position that best complements the patient's overall facial proportions.