Fixation Techniques Across Endoscopic Brow Lifts: A Scoping Review.

Since its inception, the endoscopic brow lift has gained popularity as a minimally invasive solution for treating brow ptosis. Various fixation techniques have been developed, including cortical tunnel bone fixations, reabsorbable devices like Endotine, adhesives, and simple sutures. Despite these methods, there is paucity in the literature evaluating patient satisfaction and outcomes between techniques. This scoping review aims to evaluate the existing literature on endoscopic brow lifts, focused on reporting outcomes and methods of reporting patient satisfaction. By synthesizing this information, we hope to provide clinicians with a clearer understanding of how different techniques impact patient experiences and surgical results. Our goal is to enhance clinical practice and inform future research. A licensed librarian conducted a computerized search using PubMed, Scopus, and Embase databases to identify papers from inception to June 2024. After analysis, 27 papers were included in this study. Studies were included if they examined endoscopic brow lifts using a single fixation technique and reported surgical outcome data. Due to heterogeneity in complication reporting, complications were categorized into aesthetic, neurological, wound-related, and other. This review analyzed 2519 patients across 11 fixation methods. Bone tunnel (649 patients), Endotine (333), suture (906), and screw fixation (216) were the most common. Other methods were reported in one study each. Among studies reporting gender, 85.9% were female. Ages ranged from 38.8 to 72 years, with follow-up ranging from 5.1 months to 4 years. While 74% of studies addressed patient satisfaction, only 22% quantified it. Bone tunnel fixation had the lowest complication profile across all four categories. Screw fixations had the highest rate of complications across all categories. Overall, neurological complications (11.69%) were the most common, followed by aesthetic (6.27%), other (4.94%), and wound-related (1.19%). The longevity of the endoscopic approach to address brow ptosis has driven the development of various fixation methods. Despite this, there is no clear distinction of the best approach due to the heterogeneity of the literature in reporting both surgical outcomes and patient satisfaction. Our review suggests bone tunnel fixation appears to have a favorable safety profile, while screw fixation is associated with higher rates of complications. Notably, our findings indicate that minimal complications were seen across all studies, supporting the efficacy of the endoscopic brow lift technique. There is a significant gap in the consistent reporting of complications across the literature that, if addressed, could lead to improved patient outcomes.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .