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Endoscopic brow lift dissection planes differ in exposure, lifting, and nerve safetyComparing different surgical techniques to keep nerves safe during brow lifts

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Key Takeaway
Consider dissection plane trade-offs in endoscopic brow lift: exposure vs. nerve safety.

This narrative review examines the anatomical and clinical considerations for choosing a dissection plane in endoscopic brow lift surgery. The authors compare supraperiosteal, subperiosteal, and multiplane approaches, focusing on surgical exposure, biomechanical lifting mechanisms, and risk of neurovascular injury, particularly to the deep branch of the supraorbital nerve.

Key findings are qualitative: each plane offers distinct anatomical relationships and trade-offs between exposure and nerve safety. The review does not provide pooled effect sizes or quantitative comparisons, as it is a narrative synthesis of existing anatomical and clinical evidence.

Limitations include the narrative format, which precludes quantifying comparative outcomes between techniques. The authors do not report adverse events, follow-up data, or patient-level outcomes.

Practice relevance is restrained: the review offers anatomical insights to guide technique selection based on nerve safety, but does not establish one approach as superior. Clinicians should interpret the findings as descriptive rather than prescriptive.

When a person undergoes an endoscopic brow lift, the surgeon must decide exactly where to cut and move tissue. This choice is vital because certain areas contain delicate nerves that control feeling and movement in the face. The goal is to achieve a natural look while avoiding permanent nerve damage.

A review of different surgical approaches—called supraperiosteal, subperiosteal, and multiplane—looks at how these techniques affect lifting power and safety. Each method uses a different layer of tissue to move the brow. These differences matter because they change how much of the area the surgeon can see and how much risk there is for the deep branch of the supraorbital nerve.

Because this was a narrative review, it does not provide hard numbers or prove that one specific method is better than the others. Instead, it provides a roadmap of anatomical details to help surgeons choose the safest path. It highlights the importance of understanding tissue layers to protect nerves during the procedure.

What this means for you:
Different surgical paths in brow lifts offer different levels of nerve safety and lifting power.

Common questions

How do different surgery methods affect nerve safety?

Different techniques, such as supraperiosteal or subperiosteal approaches, change how a surgeon views the area and moves tissue. These choices directly impact the risk of injury to nerves like the deep branch of the supraorbital nerve. Choosing the right path helps ensure the patient maintains feeling and movement.

What is the difference between these brow lift techniques?

The main differences lie in the anatomical relationships, how much area the surgeon can see, and the mechanical way the tissue is lifted. These factors depend on which layer of tissue the surgeon chooses to work within during the endoscopic procedure.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Endoscopic brow lift has become a widely adopted technique for upper facial rejuvenation due to its minimally invasive nature and favorable aesthetic outcomes. Compared with traditional open approaches, it offers reduced scarring, shorter recovery time, and a lower incidence of sensory complications. Three principal dissection planes are currently employed: the supraperiosteal (subgaleal), subperiosteal, and combined supra–subperiosteal approaches. Each plane differs in anatomical relationships, surgical exposure, biomechanical lifting mechanisms, and risk of neurovascular injury—particularly involving the deep branch of the supraorbital nerve. Recent anatomical and clinical studies suggest that supraorbital nerve tension plays a critical role in limiting brow elevation. Furthermore, considerable anatomical variability exists in the course of the supraorbital nerve, complicating surgical standardization. This review provides a comprehensive comparison of these three approaches, integrating anatomical insights, surgical outcomes, and clinical evidence. Particular emphasis is placed on nerve safety and the rationale for the multiplane approach, which may offer an optimal balance between surgical efficacy and complication avoidance.
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