A Comparison of Brow Elevation and Complications: Endoscopic Versus Pretrichial Brow Lift

Objectives Browlift is a common procedure to treat brow ptosis and provides lasting esthetic results with minimal morbidity. This study aimed to investigate long‐term retention of brow elevation and complication rates following endoscopic versus pretrichial browlift. Methods A retrospective chart review was conducted to collect demographic, intraoperative, and postoperative complication data on patients who underwent endoscopic or pretrichial browlift between May 2019 and February 2024 at a tertiary care institution. ImageJ Software was used for photographic assessment to calculate preoperative and postoperative brow height ratios. Results Fifty patients underwent endoscopic browlift; 22 underwent pretrichial browlift. There was no significant difference in the incidence of postoperative ecchymosis, erythema, numbness, hematoma, seroma, brow weakness, scarring, or alopecia between the cohorts ( p > 0.05). Percent change in brow height ratio at the first postoperative visit was greater in the endoscopic (21%) versus pretrichial group (13%) ( p < 0.01). Of 72 patients, 45 had follow‐up beyond 6 months (mean 429 days, range 180–984). In this subgroup, mean brow elevation ratios were 1.4 for endoscopic and 1.3 for pretrichial brow lifts, with a percent change (−2.6% vs. −2.9%) indicating no significant difference between groups from the prior visit ( p > 0.05). Multivariate analysis revealed that technique was not a significant predictor of long‐term brow height ( p > 0.05). Conclusion While both browlift techniques provide adequate brow elevation, the endoscopic technique results in significantly greater elevation in the immediate postoperative period. Given similar long‐term brow height retention and complication rates in both groups, factors such as hairline position and forehead length should guide the technique used. Level of Evidence 3.