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Whether the wrinkles are worry lines between the eyes or stretched across the forehead, cosmetic surgeons can tackle these telltale signs of aging with a single inconspicuous procedure called an endoscopic forehead lift. Often performed in concert with a mid-face endoscopic brow lift to lessen smile lines and sagging eyes, this procedure requires just four to six small incisions hidden behind the hairline, often with the aid of just local anesthesia. Through these holes a doctor can navigate an endoscopic camera and other tools that allow for the raising of periosteum tissue under the skin. This, in turn, elevates sagging surface tissue while protecting vital nerve centers.
The incisions needed for an endoscopic forehead lift are just inside the hairline at each peak, near the top of the scalp. A few cuts, creating holes about 1 inch in diameter (about 2.5 cm), are all a doctor typically needs to insert the camera and probes for the procedure. The chief goal is mining for subcutaneous tissue called periosteum, which bunches at the eyebrows as people age. Once the periosteum is secured to hooks, it is raised to a higher level, where it is permanently attached to tiny, pre-drilled holes in the skull.
Sometimes, the tiny muscles that control various facial expressions at the brows might be repositioned or trimmed during an endoscopic forehead lift. With all tissue repositioned higher, the result is a visible repositioning of the eyebrows slightly higher on the face, from the deepest levels of fat and muscle to the skin at the surface. This is usually handled with just two incisions, but sometimes others may be needed for more drastic changes.
The endoscopic forehead lift, or brow lift, is commonly performed at the same time with a mid-face lift. This latter procedure requires only outpatient care as well, and just a few more incisions — one at each temple on the scalp. The muscle and periosteum can now be lifted and otherwise adjusted at the side of the eyes, reducing smile lines, and under the eyes, to correct sagging skin. These procedures can be included with any number of other facial cosmetic surgeries that money can buy in 2011, from nose jobs and chin reconstructions to neck lifts and lip augmentations.
As a temporary alternative to an endoscopic forehead lift or mid-face lift, many turn to an injected compound called Botox®, or botulinum toxin. This is injected into areas of the face with the deepest wrinkles like between or beside the eyes, beside the nose, and from the corners of the mouth down to the sides of the chin. It can provide a noticeable-yet-fleeting improvement to aging skin, at a cost much less than surgery.
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