Forehead Eyebrow Lift Techniques: Review of the Literature and Critical Appraisal of Long-term Efficacy

Background: Forehead eyebrow lift (FEL) techniques have changed significantly over the past decades. They have slowly moved away from open coronal or hairline incision lifts toward minimally invasive endoscopic approaches. However, incomplete knowledge of functional anatomy, dynamic eyebrow muscle activity, and basic aging changes has frequently resulted in failed procedures, relapses, and an unnatural appearance with excessive brow elevation. The purpose of this review was to evaluate the long-term efficacy of open or endoscopic FEL and to highlight how evolving understanding of forehead and eyebrow functional anatomy can influence the practice of FEL procedures. Methods: A comprehensive patient/population, intervention, comparison, and outcome review of clinical studies published since 2000 in the English-language literature following preferred reporting items for systematic reviews and meta-analyses guidelines was performed using the PubMed, Embase, and Web of Science databases. Results: A small number of studies were retrieved, describing techniques that were not well standardized and had many variables. In most reports, the medial eyebrow was the least elevated, whereas the highest elevation was achieved laterally. The highest long-term elevation in all studies did not exceed 5.6 mm, and long-term follow-up demonstrated a significant gradual decrease in elevation over time. Conclusions: Open or endoscopic FEL techniques do not seem to be highly effective in maintaining long-term brow elevation, in particular laterally. It is likely time for a critical appraisal of their efficacy and for a different, more personalized conceptual approach.