Factors Affecting the Choice of Cosmetic Forehead and/or Eyebrow Lift Technique: An Oculofacial Plastic Surgeon's Perspective.

[BACKGROUND] Many different endoscopic and non-endoscopic techniques for forehead and/or eyebrow lift exist, but to date there has been little research on what factors drive technique selection.

[OBJECTIVES] To compare frequency of different forehead and/or eyebrow lift techniques between sexes, analyze factors affecting technique selection, and present an algorithm for technique selection.

[METHODS] This is a retrospective study of consecutive cosmetic patients who underwent direct eyebrow lift (DEL) or forehead/eyebrow lift (FEL) by a single surgeon between 2007 and 2022. Subjects with prior trauma or surgery, facial nerve palsy, trans-blepharoplasty technique, and functional rather than cosmetic indications were excluded.

[RESULTS] There were 1060 subjects. Three patient factors (type of lift request, hairline height, and forehead skin type) were considered in the algorithm. The most frequent procedure in female subjects was conventional endoscopic FEL (83.8%) followed by DEL (9.3%). Male subjects most frequently had DEL (63.1%) followed by conventional endoscopic FEL (16.5%). Patient factors, but not age, were significantly (p ≤ 0.001) different between the two sexes. While the above three patient factors and sex, but not age, had a significant effect (p ≤ 0.001) on technique selection on univariate analysis, sex was the only factor that remained significant (p ≤ 0.001) on multivariate analysis.

[CONCLUSION] Endoscopic FEL was the first and second most frequent technique in female and male subjects, respectively. DEL was the first and second most frequent technique in male and female subjects, respectively. Sex, but not age, was a significant factor affecting the type of lift technique through three patient factors.

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