How Do Open and Endoscopic Brow Lifts Differ, and Which Should You Choose? Effects and Complications

Key summary. A brow lift is surgery to improve drooping eyebrows and forehead wrinkles. It falls into two broad types: open techniques, which use large incisions such as coronal, direct, or temporal incisions, and the endoscopic brow lift (EBL), which uses small incisions and an endoscope. A literature review pooling 15 studies (including 4 RCTs) found that in 11 studies, the endoscopic approach produced cosmetic results similar to or better than open techniques, with complication rates generally below 5%. Open techniques are still considered for severe drooping. The types of complications differ by technique. A separate literature review pooling 76 studies and more than 10,000 patients found the highest revision rate with the hairline incision (7.4%), the highest rate of numbness with the direct incision (5.5%), and the highest rate of hair loss with the coronal incision (2.2%).

What this article covers

• Comparison criteria: incision and access method (open vs endoscopic) · types and frequency of complications by technique · whether reduced sensation recovers · recurrence and revision surgery
• Cautions: the claim that "the endoscopic approach is always safer" does not match the fact that each technique has a different complication profile, and open techniques may still be the better option for severe drooping
• Evidence status: one systematic review of open vs endoscopic techniques (15 studies, including 4 RCTs) and one literature review of complications by technique (76 studies, over 10,000 patients), both read in full. Because this is a surgical procedure, it is not subject to medical device approval by the Ministry of Food and Drug Safety (the endoscopic equipment itself is a general-purpose medical device)

Key points

1. Definition: Open techniques widely expose and lift the forehead and brow tissue through coronal, hairline, direct, or temporal incisions. The endoscopic technique enters through several small incisions with an endoscope and secures the brow with sutures or a fixation device such as the Endotine.
2. Who it suits: The endoscopic technique is generally considered for mild to moderate drooping, while open techniques are generally considered when drooping is severe or when a high hairline means forehead length needs adjusting.
3. What to check, in order: the surgeon's qualifications and experience → which technique will be used and why → whether the technique-specific complications (revision surgery, numbness, hair loss, etc.) are explained → guidance on the recovery period and how long reduced sensation lasts.

01What exactly is a brow lift?

A brow lift is surgery to improve drooping eyebrows and forehead wrinkles, and it branches into several types depending on the access method. Open techniques include the coronal incision, which runs across the entire forehead; the hairline incision, which follows the hairline; the direct incision, made directly above the eyebrow; the temporal incision, made only at the temples; and the transblepharoplasty approach, which uses an upper eyelid incision. In the endoscopic technique (EBL), several small incisions are made in the scalp, the tissue is dissected while viewing it through an endoscopic camera, and the brow position is then secured with an absorbable fixation device such as the Endotine or with sutures.

In a systematic review pooling 15 studies (4 RCTs and 11 non-RCTs), 11 studies reported that the endoscopic technique produced cosmetic results similar to or better than open techniques, with complication rates generally below 5%. However, the authors stated explicitly that the heterogeneity among these studies (differing surgeon experience, assessment methods, and follow-up periods) was so large that a meta-analysis was not possible, and the review was limited to a narrative synthesis.

02How large are the effects and complications found in studies?

The values above are based on 2026-09-19 (both papers read in full). The key point of this material is that each technique carries a different kind of complication. In a literature review that pooled 76 studies, with 2,858 patients treated by the open approach and 7,273 by the endoscopic approach, the open techniques differed from one another. The hairline incision had the highest reported reoperation rate (7.4%), the direct incision had the highest rate of numbness (5.5%), and the coronal incision had the highest rate of hair loss (2.2%). The findings therefore cannot be reduced to "the open approach is risky and the endoscopic approach is safe". The endoscopic approach (7,273 patients) generally had lower complication rates than the open approach, but hair loss (2.8%) was still its most common complication. The authors themselves stated that this review is not a meta-analysis. It collected the individual studies as they were and organized them by technique, and because definitions and follow-up periods differed between studies, direct comparisons between techniques should be made with caution.

Reduced sensation (numbness) is mostly temporary. A study comparing scalp and forehead sensation after open and endoscopic surgery found that sensation was lower in the open group at 1 to 2 weeks after surgery (scalp) and at 4 to 14 weeks (forehead). After 24 to 26 weeks, the difference between the two groups disappeared. In another cohort, patients treated endoscopically also showed reduced forehead sensation on subjective testing at 6 to 18 months, but sensation returned to normal after 18 months.

Recurrence and reoperation cases have also been reported. In one endoscopic RCT (Perez et al.), 5 of 22 patients had recurrent brow ptosis, and only 3 of them underwent reoperation. Another study (Badin et al.) reported 4 cases of medial brow drooping and 1 case of lateral brow drooping during follow-up. By technique, the hairline incision had the highest reoperation rate overall at 7.4%.

Evidence for the nonsurgical (Botox) alternative is still thin. U.S. statistics were cited showing that over the past 16 years, surgical brow lifts fell by about 64% while brow lifting with Botox rose by 797%. However, only 5 outcome studies covered nonsurgical brow lifts (672 patients: 3 on Botox, 1 on fat grafting, and 1 on radiofrequency), and recurrence and reoperation rates were not established.

03What to check before the procedure

04Choosing by situation

• Mild to moderate drooping, and you want an easier recovery → Discuss the endoscopic approach (e.g., Endotine fixation)
• Severe drooping, or you need adjustment of forehead length or the hairline → Discuss an open approach (e.g., coronal or hairline incision)
• You are concerned about a specific complication such as numbness or hair loss → Review the complication profile of each technique beforehand and raise it again during the consultation
• You are hesitant about surgery itself → Discuss nonsurgical options such as Botox, but keep in mind that only 5 studies (672 patients) support them

05Common misconceptions

"The endoscopic approach is always safer": Overall, the endoscopic approach (7,273 patients) was reported to have lower complication rates than the open approach (2,858 patients). However, the endoscopic approach still had a most common complication (hair loss, 2.8%), and some studies found that open techniques gave better cosmetic results for severe drooping. The first question is not which approach is better in general, but whether the approach fits your degree of drooping.

"Reduced sensation (numbness) is permanent": In a study comparing open and endoscopic approaches, numbness differed between groups for the first few weeks to months, but the difference disappeared after 24 to 26 weeks. Numbness reported after the endoscopic approach also returned to normal after 18 months. However, how often numbness occurs varies widely by technique, as with the direct incision (5.5%).

"Botox can fully replace it": Over the past 16 years, the popularity of Botox brow lifts is often cited as having risen by 797%. However, only 5 studies (672 patients) have looked at actual outcomes, and even recurrence and revision surgery rates are unknown. Popularity and the amount of evidence are separate questions.

06In summary

Choosing between an open brow lift and an endoscopic brow lift is not about which one is better. It is about which technique fits how much your brow has drooped and which complications you can accept. Overall, the endoscopic approach has reported lower complication rates. However, each technique has its own typical complications: revision surgery with the hairline incision, numbness with the direct incision, and hair loss with the coronal and endoscopic approaches. Loss of sensation is usually temporary, but how long it takes to recover differs by technique. Non-surgical alternatives such as Botox are growing in popularity, but the evidence on their outcomes is still thin. The practical step is to ask during your consultation which technique will be used and which complications are reported more often with that technique. If sagging in the cheeks or jawline also concerns you, beyond the eyebrows and forehead, you can read the facelift or neck lift articles. To compare lifting procedures for different areas at a glance, see the overview of lifting procedure types.

07Frequently Asked Questions

What is the difference between an open brow lift and an endoscopic brow lift?

The two differ in how the surgeon reaches the tissue. An open brow lift uses a coronal, hairline, direct, or temporal incision to expose a wide area of tissue and lift it. An endoscopic brow lift uses small incisions and an endoscope, and the tissue is secured with sutures, Endotine devices, or similar fixation methods. The techniques also differ in incision size, recovery time, and the types of complications commonly reported.

Is the endoscopic approach always better?

That cannot be said for certain. Overall, the endoscopic approach has reported lower complication rates, but it still has its own most common complication (hair loss, 2.8%). Some studies have also found that the open approach gave better cosmetic results when drooping was severe. The more important question is not which technique ranks higher but which one suits the degree of your drooping.

Does a brow lift leave permanent numbness (tingling)?

Usually not. Comparative studies found differences in the first few weeks to months, but sensation returned to normal after 24 to 26 weeks, and at the latest after 18 months. Note, however, that how often numbness occurs differs by technique (highest with the direct incision, at 5.5%).

Can I get Botox instead of a brow lift?

The honest answer is that the evidence is still thin. Only 5 studies (672 patients) have looked at outcomes of non-surgical brow lifts, and recurrence and revision surgery rates are unknown. Growing popularity does not mean the evidence is sufficient.

How likely is recurrence or revision surgery after a brow lift?

It varies by technique, and the hairline incision had the highest reported rate at 7.4%. The endoscopic approach is not free of this risk either. In one relevant RCT, 5 of 22 patients had recurrence and 3 underwent revision surgery.

08Pre-consultation checklist

• □ I have checked the operating surgeon's qualifications and surgical experience
• □ I have been told whether the open or endoscopic technique will be used and why that technique is recommended
• □ I have been told which complications are reported relatively more often with that technique (revision surgery, numbness, hair loss, etc.)
• □ I have been told how long loss of sensation is expected to last and what recovery will look like
• □ I have checked in advance the chance of recurrence or revision surgery and how it would be handled
• □ If I am considering a non-surgical alternative (such as Botox), I have also been told about the limits of its evidence

09Glossary

• RCT (randomized controlled trial): A study design that randomly divides participants into groups for comparison. It is considered relatively reliable.
• Meta-analysis: A method that statistically combines the results of multiple individual studies to reach a single conclusion.
• Heterogeneity: How much results vary from one study to another. When heterogeneity is high, it is difficult to combine multiple studies into a single calculation.

10Sources and verification date

• PMC12911988: Checked 2026-09-19. A systematic review of open versus endoscopic brow lift covering 15 studies (4 randomized controlled trials). The authors stated no conflicts of interest, and the research was funded by the university.
• PMC6250454: Checked 2026-09-19. A literature review of complications by technique covering 76 studies (2,858 patients with the open approach, 7,273 patients with the endoscopic approach, and 672 patients with nonsurgical treatment). One corresponding author disclosed a clinical consulting role with Allergan, the maker of Botox, and royalties from a medical device. Keep this in mind when reading the part of the discussion about Botox becoming more popular.
• These studies help explain how the procedures work and how strong the evidence is. They do not guarantee any particular clinic, surgeon, or outcome.

11Editorial responsibility and interests

• Written by: Korea Beauty Report Editorial Team, Editorial responsibility: Korea Beauty Report Editorial Team
• Review scope: The editorial team prepared this content from published research and public data. It was not separately reviewed by a medical professional and does not replace individual diagnosis or treatment.
• Conflicts of interest: No clinic mentioned in this article has a contract or advertising relationship with us.
• First published: 2026-09-26, Sources last checked: 2026-09-26