Postoperative Forehead Elongation Linked to Frontalis Relaxation Not Tissue Migration

Endoscopic brow lift remains a primary surgical intervention for correcting brow ptosis, achieving pooled long-term elevation of 3.25 mm medially and 4.35 mm laterally [1]. While the procedure is favored for its minimally invasive nature, longitudinal data show a discrepancy in outcomes, with 70% of patients reporting satisfaction compared to only 50% of surgeons regarding long-term results [2]. These aesthetic shifts are complicated by the preoperative hyper-contraction of the frontalis muscle, a compensatory mechanism where the forehead muscle overworks to lift sagging tissues [3]. Despite the use of various fixation methods, such as bone tunnels which demonstrate a lower complication profile than screw-based systems, objective quantification of postoperative rejuvenation has remained difficult [4]. Recent analysis using convolutional neural networks (a type of artificial intelligence that identifies patterns in visual data to estimate age) indicates that brow lifts independently reduce perceived age by an average of 1.432 years (p =.031) [5].