In short
- 🔑 The advantage that matters: the scar does not show. It goes inside the hair, and compared with any other brow lift — direct, pretrichial, coronal — it is the one that leaves the least trace.
- Here it is done with two incisions a couple of centimetres long inside the scalp, and without a camera: access is gained through a subcutaneous tunnel.
- 🔑 That is the practical difference. Doing without the endoscope allows two incisions instead of three to five and less undermining, and less undermining is what translates into less swelling and a more bearable recovery.
- The lift holds. A 2025 meta-analysis focused on long-term stability gives 3.25 mm at the head of the brow, 3.86 mm at the centre and 4.35 mm at the tail. And at 5.4 years the position persists in every zone except the tail.
- The brow is anchored with a bone tunnel and suture, which is the fixation with the fewest dysaesthesias — abnormal sensations in the scalp — of those studied.
- General anaesthetic, and usually as a day case.
- ⚠️ Like any surgery, it has complications, and their profile differs from that of the open techniques: more sensory ones and more alopecia, fewer scar ones. They are set out below, with figures.
- It is indicated above all in mild to moderate brow ptosis.
It is the brow operation most often asked for by name, and almost always for the same reason: it does not leave a scar that shows. That is true, and it is its real advantage.
What almost nobody explains is that the word “endoscopic” covers quite different ways of doing it, and that the one used here does not involve a camera. This page explains how it is done, how much it lifts according to the evidence of recent years, and which brow it suits.
How it is done here: without a camera and with two incisions
It is worth starting with the name, because it misleads. “Endoscopic” describes how the technique was born in 1992: through small incisions in the scalp, with an endoscope — a fine camera — that projected the image onto a monitor and made it possible to work without opening the forehead.
Here it is done without a camera. Access is gained through a subcutaneous tunnel, and that changes two specific things:
| With an endoscope | As it is done here | |
|---|---|---|
| Incisions in the scalp | Three to five | Two |
| Undermining | As much as moving the optics demands | The minimum needed to release and fix |
🔑 Less undermining is less swelling. It is not a finishing detail: undermining is what determines how much a forehead swells, how long it takes to settle and how long the numb feeling lasts. Working through a tunnel, instead of creating the space a camera needs to manoeuvre, reduces all of that.
Three things are done through that access:
- The forehead is released in the plane needed for the tissue to be able to rise.
- The orbital rim is released, which is what allows the brow to rise for real, and the depressor muscles of the brow and the glabella — the ones that pull downwards — are addressed.
- The forehead is fixed in its new position with a bone tunnel and suture.
The anaesthetic is general. It is usually a day case, although it can also be done with an overnight stay if the case or the patient makes that advisable.
⚠️ An honest caveat about the figures on this page: the studies cited below describe series done with an endoscope, not this variant. Their numbers serve as context for the technique, not as the rates of any particular practice — and that goes for any page publishing percentages, including this one.
The scar: the reason it is chosen
It is the first thing anyone landing on this page asks, so it comes before anything else.
The incisions go inside the scalp, behind the hairline. They are a couple of centimetres long, the hair covers them and there is no scar on visible skin. Compared with the alternatives:
- The direct lift leaves the incision just above the brow.
- The pretrichial leaves it at the hairline, exposed.
- The coronal crosses the scalp from ear to ear.
🔑 Of all the ways of raising a brow surgically, this is the one that leaves the least visible trace. And with two incisions instead of five, less still.
⚠️ What can happen around a scalp incision is alopecia: a strip without hair along the scar. Reviews put it at around 3% for this technique — against 8.5% for the approach that runs along the hairline with subcutaneous dissection — and it is usually temporary.
How much it lifts, and how much holds
This is the question the technique had to answer, and it answered it.
A 2025 meta-analysis set out to do exactly that — how much it lifts and how long it lasts — and screened 5,324 articles to keep the 12 that had usable measurements. The pooled long-term lift effects:
| Part of the brow | Lift maintained |
|---|---|
| Head | 3.25 mm |
| Centre | 3.86 mm |
| Tail | 4.35 mm |
And a study of 31 patients followed for 5.4 years found that the lift persisted in every zone except the tail of the brow, that the reduction in glabellar lines also held, and that 64% of patients were still judged better than before surgery.
🔑 Three or four millimetres sound like little and are not. On a brow, a millimetre changes the expression. What these figures say — and it is the relevant point — is that what is gained is not lost: it is not a result that lasts a year.
⚠️ And they also mark the limit. A technique that lifts three or four millimetres does not resolve severe ptosis, nor does it replace a blepharoplasty when what is in excess is eyelid skin.
How the brow is anchored
It is the most technical part and the one that really separates one result from another.
Here it is fixed with a bone tunnel and suture: a small tunnel is cut in the cortex of the frontal bone and the stitch that holds the forehead in its new position is anchored to it. It is an anchorage to bone, which is the only point that does not give.
The meta-analysis of 2,127 brows compared fixation methods and found a trade-off worth knowing about:
- Barbed implants achieve slightly more lateral lift than suture.
- And also significantly more dysaesthesia — abnormal sensations in the scalp, which is one of the complaints that lingers longest after surgery.
🔑 Suture over a bone tunnel is the quiet side of that trade-off, and it is the one chosen here: a little lateral lift is exchanged for a scalp that bothers you less. In an operation whose aim is three or four millimetres and whose most frequent complaint is sensory, that division makes sense.
That same meta-analysis also compared where the incision goes and found no significant differences in long-term lift or in complications between the pretrichial approach — at the hairline — and the one that runs behind it.
The complication profile, with the figures in view
No brow technique is free of complications, and the systematic reviews show that it is not that some have more and others fewer: it is that each has its own.
| Technique | What comes up most |
|---|---|
| Endoscopic, subperiosteal dissection | Paraesthesia 6.2% · Asymmetry 3.6% · Alopecia 3.0% · Lagophthalmos 2.7% |
| Coronal, subgaleal dissection | Unacceptable scar 3.6% · Haematoma 0.5% · Infection 0.2% |
| Hairline, subcutaneous dissection | Alopecia 8.5% · Paraesthesia 5.4% · Unacceptable scar 2.1% · Skin necrosis 1.8% |
A second review, of 76 studies, spreads the picture further still: the highest alopecia is indeed the endoscopic one (2.8%), but the highest revision rate belongs to the hairline technique (7.4%), the highest numbness to the direct technique (5.5%) and the highest asymmetry to the temporal technique (1.5%).
🔑 The correct reading of the two tables is this: the endoscopic approach concentrates its complications in sensation and in hair, and the open ones in the scar. Choosing a technique means choosing which profile you prefer, not looking for the one that has none.
⚠️ And the figures have to be read with caution, as their own authors ask: they are weighted proportions from case series, not from comparative studies, and a well-designed trial comparing them head to head is still missing.
A note of history, because it explains the scepticism
If you ask two surgeons about this technique you may get two opposite answers, and there is a reason for that.
In 2003, a leading hospital published a review of 628 procedures and found that its numbers had fallen by 70% at that institution. Of twenty-one surgeons surveyed, 25% no longer performed it, and although 70% of patients were satisfied, only 50% of surgeons were happy with results beyond two years. The authors put it down to selection criteria that were too broad and to insufficient efficacy in some patients.
✅ And the story ended well, which is the part almost nobody tells. That paper is more than twenty years old. What the technique was challenged on — that it would not last — is exactly what the meta-analyses of 2025 and 2026 have answered with objective measurements and years of follow-up. Patient selection was refined, fixation improved, and durability stopped being the problem.
Who it is indicated for
The literature places it above all in mild to moderate brow ptosis, and here it is the usual recommendation in younger patients, with the forehead still smooth: there is no line in which to hide an incision, so hiding it inside the hair is the best solution available.
⚠️ One nuance worth bearing in mind: because the approach works behind the hairline, it tends to move it backwards, if only a little. On a forehead that is already high, that may not be wanted — and that is where the approaches that run along the hairline itself come in, or forehead reduction, which does precisely the opposite.
In older patients, with the forehead already lined, the direct lift tends to gain ground, since it makes use of an existing furrow. The other families of technique and how each compares are on the general brow lift page.
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Frequently asked questions
Is it done with a camera?
Not here. The name “endoscopic” comes from how the technique was born, with an endoscope. In this practice access is gained through a subcutaneous tunnel, without a camera, and that allows two incisions instead of three to five and less undermining, with less swelling afterwards.
Does it leave scars?
Two, short ones, inside the scalp. There is no scar on visible skin, and it is the brow technique that leaves the least trace of all. What can appear around them is a strip without hair, usually temporary, at around 3% according to the reviews.
How long does it last?
A 2025 meta-analysis focused on long-term stability found lifts maintained at 3.25 mm at the head of the brow, 3.86 mm at the centre and 4.35 mm at the tail. At 5.4 years of follow-up, the position persisted in every zone except the tail.
What anaesthetic, and will I stay in?
A general anaesthetic. It is usually a day case, although it can be done with an overnight stay if the case makes that advisable.
How is the forehead held in its new position?
With a tunnel cut in the frontal bone to which the suture is anchored. Barbed implants are not used: they achieve slightly more lateral lift, but also more abnormal sensations in the scalp, and in this surgery that exchange is not worth it.
Does it have more complications than an open lift?
It has different ones. The systematic reviews show that the endoscopic approach concentrates its complications in sensation and in alopecia, and the open techniques in the scar. There is no technique without complications; there is the one that best fits each anatomy.
What is lagophthalmos?
Being unable to close the eye completely. In brow surgery it is usually temporary and appears when the lift goes further than the eyelid can follow. It is explained on the page about risks of the upper third.
Will it raise my hairline?
It may move it back somewhat, because the approach works behind it. On a forehead that is already high that may not be wanted, and there are alternative approaches that run along the hairline itself.
Sources
- Byun S, et al. Complications of browlift techniques: a systematic review. Aesthetic Surgery Journal, 2013. PMID 23388642. — A search of eight databases, 82 studies included and proportions weighted by random-effects model: endoscopic techniques with subperiosteal dissection had the highest rates — paraesthesia 6.2%, asymmetry 3.6%, alopecia 3.0%, lagophthalmos 2.7%; coronal incision with subgaleal dissection — unacceptable scar 3.6%, haematoma 0.5%, infection 0.2%; anterior hairline with subcutaneous dissection — alopecia 8.5%, paraesthesia 5.4%, unacceptable scar 2.1%, skin necrosis 1.8%; the authors conclude that endoscopic techniques are associated with a wider variety of complications than open approaches and that a well-designed comparative study is needed.
- Cho MJ, Carboy JA, Rohrich RJ. Complications in Brow Lifts: A Systemic Review of Surgical and Nonsurgical Brow Rejuvenations. Plastic and Reconstructive Surgery – Global Open, 2018. PMID 30534495. — 76 studies: the highest revision rate in the hairline lift (7.4%), numbness in the direct lift (5.5%), asymmetry in the temporal or lateral lift (1.5%) and alopecia in the endoscopic lift (2.8%); each technique has a different complication profile; prospective randomised studies and standardised outcomes are lacking.
- Şibar S, Dikmen AU, Erdal AI. Long-term Stability in Endoscopic Brow Lift: A Systematic Review and Meta-Analysis of the Literature. Aesthetic Surgery Journal, 2025. PMID 39542644. — 5,324 articles screened and 12 studies included; pooled long-term lift effects of 3.25 mm at the medial brow, 3.86 mm at the central brow and 4.35 mm at the lateral brow; the first meta-analysis of the mean lift achievable in the long term with this technique.
- Chiu ES, Baker DC. Endoscopic brow lift: a retrospective review of 628 consecutive cases over 5 years. Plastic and Reconstructive Surgery, 2003. PMID 12900626. — Review of 628 procedures performed between 1997 and 2001 at the Manhattan Eye, Ear and Throat Hospital, with a 70% fall in the number of procedures; survey of 21 plastic surgeons: 25% performed it routinely, 50% occasionally and 25% no longer performed it; 70% of patients satisfied against 50% of surgeons happy with results beyond two years; 71% administered botulinum toxin within the following six months; the authors conclude that there is no single superior surgical procedure for managing brow ptosis.
- Jones BM, Lo SJ. The impact of endoscopic brow lift on eyebrow morphology, aesthetics, and longevity. Plastic and Reconstructive Surgery, 2013. PMID 23897351. — 31 patients with 5.4 years of follow-up after subperiosteal endoscopic lift: an objective lift of under 5 mm that persisted in every zone except the tail of the brow; significant and sustained reduction of glabellar lines with resection of the depressor muscles; 64% of patients were still judged better than before surgery.
- Karanfilian T, et al. Long-Term Brow Lift Outcomes: A Systematic Review and Meta-Analysis. Ophthalmic Plastic and Reconstructive Surgery, 2026. PMID 40788666. — 22 studies and 2,127 brows: no significant differences in long-term lift or in complications between pretrichial and post-trichial approaches; fixation with barbed implants achieved greater lateral lift and higher rates of dysaesthesia than fixation with sutures.
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If you have come here looking for this technique in particular, the useful conversation in the consulting room is not “do you do it endoscopically?” but “what does my brow and my hairline call for?”. At our practice in Valencia that is what is examined, and you are told which approach is proposed and why, with its advantages and its drawbacks spelled out.
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Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
