Long-term Stability in Endoscopic Brow Lift: A Systematic Review and Meta-Analysis of the Literature

Long-term stability and recurrent ptosis are among the most debated topics in endoscopic brow lifts. Although there are many publications on endoscopic brow lifts, more research is needed on long-term brow elevation and stability. In this systematic review we aimed to evaluate the amount of elevation and stability achieved by endoscopic brow lifts in the long term. To evaluate the long-term outcomes of endoscopic brow lifts, the databases PubMed, Web of Science, Scopus, and Google Scholar were searched with the keywords "endoscopic brow lift," "endoscopic forehead lift," "forehead lift," "foreheadplasty," "brow lift," "endoscopic brow fixation," and "brow fixation." Studies published between September 1994 and May 2024, including isolated or combined endoscopic brow lift surgeries, were included. In total, 5324 articles were screened, and 85 full texts were reviewed. Of these studies, 12 (14.1%) were found suitable for systematic review and meta-analysis. Brow elevation values were evaluated separately by medial, central, and lateral parts. The pooled effect sizes for medial, central, and lateral brow elevations were found to be 3.25 mm (2.44-4.06), 3.86 mm (2.93-4.8), and 4.35 mm (3.06-5.64), respectively. This study is the first meta-analysis to present the average elevation values that can be achieved in the long term by endoscopic brow lifts. These data guide a better understanding of patient candidates and endoscopic brow lift technique. Sharing more objective data over the long term about different fixation methods will contribute to a better understanding of the criteria related to indications for this surgery.