Comparative Outcomes of Traditional Versus Endoscopic Brow Lift Techniques: A Systematic Review

Background: Age-related changes in the brow region, such as sagging, asymmetry, and deepening of forehead lines, pose significant cosmetic and functional challenges. Various surgical approaches have been developed over the decades to address these issues. This systematic review compared traditional open techniques versus endoscopic and minimally invasive brow lift techniques in terms of aesthetic outcomes and complication rates. Methods: A comprehensive search was conducted in PubMed, MEDLINE, the Cochrane Library, Embase, and ClinicalTrials.gov. Studies published during the past 20 years that met our predefined eligibility criteria were included. The quality of randomized controlled trials was assessed using the Cochrane Risk of Bias 2 tool, and nonrandomized studies were evaluated with risk of bias in non-randomized studies of interventions (ROBINS-I). Data on aesthetic outcomes and complications were extracted and compared across studies. Results: Fifteen studies were included in this review. The evidence suggests that although various open brow lift techniques provide satisfactory elevation, they are generally associated with higher complication rates and less favorable cosmetic results. In contrast, endoscopic and minimally invasive techniques, including the use of Endotine devices and gliding brow lifts, demonstrate comparable or superior aesthetic outcomes with lower complication rates and reduced recovery times. However, heterogeneity in outcome measures and study designs limits the strength of these conclusions. Conclusions: Endoscopic and minimally invasive brow lift procedures seem to offer cosmetically favorable results with lower complication rates compared with traditional open techniques. Nevertheless, further high-quality, prospective studies are needed to definitively establish the long-term efficacy and safety of these approaches.