The goals of surgical rejuvenation of the forehead include component brow manipulation, attenuation of transverse forehead rhytids, and reduction of glabellar frown line. The endoscopic approach has proved successful in achieving these goals in selective patients while minimizing incisions and improving scalp sensation.
But during the initial presentations, the endoscopic approach was criticizing for showing early relapse or for not obtaining enough brow elevation and many surgeons still question the efficacy of this procedure.
So, we review the concept of the mechanism causing eyebrow ptosis and present the critical components for success as followings: (1) forehead dissection at the subperiosteal plane to release the zone of fixation and the periosteal attachment from the superior orbital rim, (2) transection of the orbital ligament for unrestricted transposition, (3) brow depressor muscle resection, (4) lateral temporal expansion using non-absorbable sutures, (5) tension-free fixation of the brow position until wound healing has occurred. With this technique, a more controlled eyebrow position and eyebrow shape can be achieved.