Endoscopic Forehead Lift: Bone Tunneling vs Endotine Fixation, A Comparison of Methods and Results

As we age, the forehead and eyebrows gradually descend, which can make the upper eyelids appear heavier and the eyes look tired or less open. As the forehead muscles lose elasticity and the skin becomes lax, people may also develop a habit of unconsciously lifting their eyebrows.

These changes can make the eyes look smaller and create a heavier or more fatigued expression. For this reason, many patients consider forehead lift surgery to achieve a more fundamental improvement.

Recently, endoscopic forehead lift surgery has gained attention as a safe and natural lifting method that minimizes the size of incisions and may allow for a relatively shorter recovery period.

Q. What is an endoscopic forehead lift?

An endoscopic forehead lift is a surgical procedure in which small incisions are made inside the hairline, an endoscope is used to safely release the tissues, and the descended forehead and eyebrows are lifted and fixed in a higher position.

Because only small incisions are required, scarring can be minimized and recovery is generally faster.

With the aid of an endoscope, the surgeon can directly visualize the tissues and safely separate the forehead structures. This allows the surgeon to confirm whether the forehead and eyebrows are being lifted evenly and whether the overall facial expression remains balanced.

In addition, patients with a short distance between the eyebrows and eyes, or those with naturally straight eyebrows that create a strong or stern appearance, may have limitations in achieving a satisfactory result with double eyelid surgery alone.

In such cases, an endoscopic forehead lift can serve as a fundamental solution by repositioning the forehead and eyebrow area.

When a descended forehead and eyebrows are lifted to a more appropriate position, the compressed space around the upper eyelids becomes more open, helping create a clearer and more natural eyelid line.

At the same time, the overall eye shape may appear more open and balanced, while asymmetry around the left and right eye areas can also be improved. Rather than simply creating a double eyelid crease, forehead lift surgery simultaneously repositions the forehead and eyebrows, allowing for a more natural eyelid line, improved symmetry, and better eye opening as part of a comprehensive improvement in the appearance of the eyes.

Q. Why is the fixation method important in endoscopic forehead lift surgery?

The key to endoscopic forehead lift surgery is not simply lifting the tissue, but how securely the lifted tissue is fixed and how well that fixation is maintained over time.

The appropriate fixation method can vary depending on factors such as skin thickness, skin elasticity, muscle movement, and the condition of the scalp. Selecting the correct method can influence both the completeness of the surgical result and how well the result is maintained.

If a fixation method that is not appropriate for the individual patient is used, the forehead may gradually descend again over time or the result may not be maintained for as long. For this reason, selecting the fixation method is just as important as the surgery itself.

AB Plastic Surgery performs both bone tunneling fixation and Endotine fixation, which are among the most commonly used fixation methods for endoscopic forehead lift surgery, allowing the surgical approach to be tailored to each individual patient.

Q. How is Endotine fixation performed in forehead lift surgery, and what are its characteristics?

During an Endotine forehead lift, the descended forehead tissues are safely released with the assistance of an endoscope. A fixation device called Endotine is then inserted to secure the forehead in its lifted position.

AB Plastic Surgery uses genuine Endotine devices and has been designated as a specialized medical institution using authentic Endotine products. Endotine is made from a bioabsorbable material that is gradually absorbed naturally by the body over time.

Characteristics of Endotine Forehead Lift

✅ Provides strong fixation over a broad area, helping prevent the forehead from descending again

✅ Reduces the burden on the skin and fixation area and may help improve deeper wrinkles

✅ Gradually absorbed by the body over approximately one year while supporting a stable and long lasting lifting effect

✅ Particularly suitable for patients with thick scalp tissue or strong forehead muscle activity

Q. How is bone tunneling fixation performed in endoscopic forehead lift surgery, and what are its characteristics?

After making small incisions and safely releasing the forehead tissues using an endoscope, bone tunneling fixation secures the descended forehead tissues firmly using specialized medical sutures that are absorbable within the body.

The specialized medical sutures used for this technique are safe absorbable materials commonly used in surgery. When an endoscopic forehead lift is performed with bone tunneling fixation, there is no need to worry about a foreign body remaining permanently inside the body.

Characteristics of Bone Tunneling Forehead Lift

✅ Uses a bone based tunnel to securely anchor the sutures

✅ Lifts the forehead tissue from the descended brow area toward the medial eyebrow region, allowing adjustment of the position and angle of the eyebrows

✅ Does not require a separate fixation device

✅ Provides more detailed adjustment of the brow position and may help reduce discomfort related to foreign material

Q. Endoscopic Forehead Lift: Bone Tunneling vs Endotine. Which fixation method is more suitable for me?

The appropriate fixation method varies depending on skin thickness, skin elasticity, muscle movement, scalp condition, and other individual factors.

Endotine Forehead Lift May Be Recommended If:

✅ You want strong lifting and fixation

✅ You have deep wrinkles or significant forehead drooping

✅ Your scalp is thick

Bone Tunneling Forehead Lift May Be Recommended If:

✅ There is significant drooping around the inner eyebrow area

✅ The position of the eyebrows needs detailed adjustment

✅ Your scalp and forehead skin are relatively thin

Careful tissue release and fixation tailored to each patient are essential elements of safe and effective lifting surgery. Both fixation methods have established safety and effectiveness.

It is important to select the forehead lift fixation method that is most appropriate for the individual patient through consultation and evaluation with an experienced medical professional.

AB Plastic Surgery does more than simply lift descended forehead and eyebrow tissues. We perform customized endoscopic forehead lift surgery while considering the movement of the forehead muscles and the overall balance of the eyebrow line.

Every stage of the procedure, including the selection of fixation materials, the location of the incisions, endoscopic tissue release, and detailed fixation performed by experienced medical professionals, is planned as an integrated process to maximize natural and stable lifting results.

In some cases, double eyelid surgery or upper blepharoplasty may also be performed together with forehead lift surgery.

By comprehensively evaluating the forehead, eyebrows, and upper eyelids when planning surgery, a more natural result can be achieved without creating an artificial or overly operated appearance.

In particular, the fixation method and degree of tissue release may vary according to scalp thickness, skin elasticity, and the development of the forehead muscles. Therefore, an experienced specialist’s surgical technique and accurate diagnosis are important.

For this reason, if you are considering endoscopic forehead lift surgery, it is important to receive sufficient consultation regarding your desired eye and facial appearance and to undergo surgery at a medical institution capable of applying the most appropriate fixation method for your individual condition.

Through the before and after photographs shown above, we reviewed the results of endoscopic forehead lift surgery and the differences between bone tunneling and Endotine fixation methods.

If you have any questions about endoscopic forehead lift surgery,  please contact AB Plastic Surgery on WhatsApp at +82 10 4393 1298 for a detailed consultation.

Writer, Dr. Choi Jae-Ik, AB Plastic Surgery