A video-assisted brow lift is indicated when brow position contributes meaningfully to upper-eyelid crowding, asymmetry or a tired expression. It should not be used to create the same high lateral brow in every face. Brow shape, forehead height, hairline, frontal-muscle compensation, eyelid margin and orbital support determine the plan.
First separate brow descent from eyelid disease
| Finding | What it may represent |
|---|---|
| Upper-lid hooding | Skin excess, brow descent or both |
| Constant forehead contraction | Frontalis compensation for a low brow, ptosis or heavy eyelid |
| Low eyelid margin | True eyelid ptosis rather than a brow problem |
| Upper-orbital hollowing | Volume loss or previous overresection |
| Asymmetry after Botox | Temporary change in muscle recruitment rather than stable anatomy |
Removing upper-eyelid skin cannot raise a descended brow. Conversely, brow surgery is unnecessary when the brow is stable and the dominant problem is skin excess or true ptosis. Dr. June evaluates the forehead, brow and eyelid as one functional system before choosing Hybrid Blepharoplasty, brow surgery, ptosis correction or a staged combination.
How the video-assisted approach is planned
Dr. June’s upper-face approach commonly uses four or five small scalp portals. The frontal dissection proceeds in a subperiosteal plane. Release of the orbital retaining ligament and arcus marginalis allows tissue repositioning; the temporal dissection respects the fusion line, sentinel vein and course of the frontal facial-nerve branch.
Fixation is individualized with a bone tunnel, small screw or fascial support according to anatomy and vector. The preferred movement is generally vertical repositioning rather than excessive lateral traction. Corrugator and procerus treatment is conservative, because expression and nerve function matter more than eliminating every glabellar line.
Incision size does not describe the internal operation
“Minimally invasive” refers mainly to scalp incision placement. The internal release can be extensive. The approach does not remove forehead skin or shorten a high forehead. A pretrichial hairline incision may be more appropriate when forehead reduction is an important objective. A direct or Castanhares-type approach may be selected for functional lateral excess in an older or medically complex patient who accepts a visible scar.
Long-term morphometric studies found maintained brow elevation after both endoscopic and pretrichial approaches, without a significant long-term difference between techniques in one 65-patient series. Hairline, forehead length, scar trade-offs and the required vector should therefore guide selection rather than a claim that video assistance is universally superior.
How much elevation is realistic?
A five-year study of 31 endoscopic brow lifts found subtle average elevation under 5 mm, maintained in most brow regions but with more relapse at the tail. A 2024 meta-analysis estimated long-term elevation of approximately 3 to 4 mm across the medial, central and lateral brow. These pooled values are not targets for an individual face. Millimeters alone do not define a good result; expression, symmetry and eyelid function must remain coherent.
Previous Botox and injectables matter
Botulinum toxin changes frontalis and depressor activity and can temporarily alter brow height. Product, dose, injection map and date should be documented. Fillers, threads, biostimulators and energy treatments may change planes or cause inflammation. Dermatologic ultrasound may be useful when material is uncertain.
Risks and recovery
Risks include hematoma, infection, delayed healing, visible scalp scars, hair thinning, pain, itching, sensory change, fixation failure, asymmetry, over- or under-correction and revision. Temporary frontal weakness can occur; persistent motor dysfunction is uncommon but possible. A new movement deficit requires examination.
Swelling and bruising can extend around the temples and eyelids. Scalp numbness, tightness and temporal pain with chewing may persist beyond social recovery. Scalp sutures are commonly removed around day 15, while brow position and sensation continue to settle over weeks to months. A patient-reported series found numbness in 63% and incision-site alopecia in 28%, emphasizing that small incisions do not mean symptom-free recovery.
International-patient planning
Assessment can begin remotely, but final indication and vector require in-person dynamic examination. Surgery is performed in hospital with anesthesia and postoperative monitoring. International patients generally plan at least 15 days in Brazil, adjusted to recovery. Belvivere’s concierge coordinates local logistics; the medical team controls follow-up and flight clearance.
