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Q & A with Dr. Hoenig:

cost for endoscopic browlift

"Can you give me an approximate estimate of what Dr. Hoenig charges for a browlift?"

The most common technique I use for a browlift is the endoscopic approach, using very small incisions hidden in the scalp, and long instruments. The cost for this is about $6000 including the surgeon's fee, operating room, and anesthesia. This also includes all your post op visits.

There are many different ways to do a browlift. The right one for you will depend on your anatomy, age, gender, and hair distribution.

Here is a rundown on the different types of browlifts:

coronal browlift (coronoplasty or headband incision) : The coronal method of brow lift surgery (coronal means crown-like) uses an incision from ear to ear to lift the forehead and then remove excess skin from the scalp. Since the entire forehead flap and all of the muscle and bone are easily visible, this is technically the simplest browlift to perform. The coronal incision will lengthen the forehead and raise the hairline as the forehead is lifted. This is beneficial for someone with a short forehead, but not desireable in patients with an already long forehead. The coronal lift is not commonly the preferred method anymore due to hair loss, numbness, scarring and a greater recovery time.

endoscopic browlift (also referred to as "endobrow") : Using a tiny camera and long instruments inserted through 5 or 6 small incisions in the scalp, the forehead is separated from the bone and lifted. Sutures, screws, or staples are used to hold the forehead flap in place for a few weeks while it heals so that it does not slip back down. (see fixation techniques below) No skin is removed with the endoscopic technique, so this is not the best approach with someone with alot of excess forehead skin and wrinkling. Loss of sensation is minimal, especially when compared to the persistent numbness following the coronal lift (see above). Minimal scarring does make it beneficial for men with little or no hair to cover the scars.

temporal or lateral browlift : With a temporal or lateral browlift, the incisions are placed within the hair-bearing areas at the temples towards the side of the face. Excess skin is removed, lifting the outer corners of the brow. This method will not raise the middle of the brow, but it can help to alleviate crow's feet (wrinkling at the corners of the eyes) somewhat. The temporal browlift is ideal for patients whose only concern is drooping of the tail of the eyebrow. It can also be done in conjunction with an endoscopic browlift or with a facelift.

mid-forehead browlift : Using the midforehead browlift method, an incision is made in a deep wrinkle in the middle of the forehead. Sometimes more than one incision is placed in different furrows. (These deep furrows are a result of involuntary forehead muscle contraction to raise the drooping eyebrows). The brows are then lifted, and excess skin removed. With careful suturing, the scar will disappear into the crease once it has healed. This procedure is best for men with heavy foreheads and deep wrinkling, and is useful in men with an already high hairline since this technique will lower the hairline.

direct browlift : With the direct browlift, the incision is placed immediately above the brows and follows the natural curve of the eyebrow. Like the midforehead lift, it will not raise the hairline. With careful surgical techniqe and meticulous suturing, the scars should be barely noticeable.

pretrichial or hairline browlift : By definition, the incision for a pretrichial or hairline browlift is made in front of the hariline at the top of the forehead, although in practice the incision is usually a few millimeters into the hairline. The forehead and brows are lifted, and excess skin is removed. This procedure works well for someone who has a full head of hair, and who does not want the longer forehead or higher hairline that will likely result from a coronal or endoscopic browlift. The scar may be visible in patients who wear their hair pulled back off of the face.

trychophytic browlift : Similar to the pretrichial lift, but the incision is just barely within the hairline (as opposed to the pretrichial where the incision is by definition just barely outside of the hairline).

transpalpebral browlift : The transpalpebral browlift is performed through incisions made only in the upper eyelid creases. This technique is useful in bald men who do not require skin removal and mostly desire a permanent weakening of the brow and forehead muscles, rather than a lift. The transpalpebral incison can also be used for corrugator muscle excision (see below) and brow bone reduction (see below).

corrugator muscle excision : The corrugator is the muscle that allows your eyebrows to squeeze together when your frown or worry. Either as a procedure by itself or in conjunction with a browlift, removing part of the corrugator muscle will yield a more relaxed appearance and inability to create lines between the eyebrows. The result is similar to having Botox injections between the eyebrows, but the results of corrugator excision are usually permanent. In some instances, cutting out too much muscle can cause visible contour irregularities or depressions from where the muscle was taken. If corrugator excision is done with a browlift, the incision is placed within the crease of the eyelid.

brow bone reduction : also known as orbital rim contouring or brow shave. (This is not a browlift, but is another option in shaping the brow and forehead). Brow bone reduction is used to minimize the appearance of deep set eyes, or for men desiring more feminine features. Orbital rim reduction involves burring down the brow bone to make it less prominent. This can be done through an incision in the upper eyelid crease, or through an incision in the scalp (such as the coronal browlift incision). The procedure can be performed with IV sedation. The greatest risk is of contour irregularities, but nerve damage or frontal sinus damage can also occur. This surgery should only be done by a doctor experienced with this procedure.

brow fixation : In some patients, removing upper eyelid skin without fixating the brow will result in further brow descent and a recurrence of upper eyelid hooding. In this case, the patient will be concerned a few months after surgery that the doctor did not remove enough skin because the brows are being pulled down. To prevent this, a procedure is done similar to a browlift, but without raising the eyebrows. As the forehead flap heals, it will adhere in it's new position, anchoring the eyebrows and preventing brow drooping with upper eyelid surgery. Most people do not need brow fixation, but careful examination and observation is required by the surgeon to detect this before surgery.

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