The rationale for the use of the endoscope, the operative procedure, potential complications and results are presented. Periostial release Figure 12. A limitation to the application of the operative endoscope in facial cosmetic surgery has been the lack of a naturally occurring optic space. By utilizing a retractable outer sleeve around the endoscope which has a 30 bevel, adequate optic space can be created, allowing for safe performance of browlift surgery. Through these incisions the instruments are passed and the pericranium and galea are elevated.
Care is taken to protect the supraorbital neurovascualr bundles bilaterally.
The corrugator and procerus muscles are exposed and avulsed. The branches of the trochlear nerve which pass through the medial corrugator muscle can be identified and protected. Cross-cutting and weakening of the frontalis muscle can also be performed through the endoscope with low power electrocautery. Extension of the dissection laterally to the plane beneath the superficial temporal fascia and inferiorly along the lateral orbital margin can be performed to allow for lateral browlift. Brow elevation is accoplished by redapring the forehead soft tissues posteriorly and suspending them either with sutures, temporary screws to the external calvarium, or taping.