The standard subgaleal coronal incision used for brow lifting is limit
ed to patients with low foreheads. The subcutaneous hairline brow lift
used for patients with high foreheads has a high rate of vascular com
plications. However, the main advantage of the subcutaneous approach i
s preservation of sensation posterior to the incision line. The subper
iosteal approach, on the other hand, allows a better periorbital remod
eling. I have combined the subperiosteal and the subcutaneous approach
to take advantage of and minimize the disadvantages of each individua
l approach. The advent of the endoscopic technique has allowed more ac
curate and controlled periorbital dissection and brow depressor muscle
modification. The operation is indicated in every patient in whom the
anterior hairline incision is indicated. It is a good method for decr
easing the height of the forehead. The dissection is done initially in
the subcutaneous plane, and about halfway on the forehead slit incisi
ons through the galea-periosteal layer and through the temporoparietal
fascia are made to continue the dissection in the deep plane. The per
iosteal dissection and release at the arcus marginalis is done under e
ndoscopic control. Likewise, the brow depressor muscle modification is
done under endoscopic magnification. Deep anchoring sutures fix the b
row in the elevated position. Trimming and closure of the cutaneous la
yer are done with minimal tension. The biplanar subperiosteal-subcutan
eous forehead lift has been used in 24 patients with very satisfactory
results. Complications have been of a minor nature. Patients have mai
ntained sensation posterior to the hairline incision. The height of th
e forehead has been decreased in every case. Frontalis muscle function
has been preserved.