Forehead Lift Fixation Methods: Which Is Better, Endotine or Suture Fixation?

One of the areas where changes first become noticeable with age is the forehead and the area around the eyes.

As the forehead skin and eyebrows droop downward, forehead wrinkles deepen, and sagging eyelid skin may create a stuffy or tired appearance.

These changes are not simply a problem with the eyelids; they are closely related to changes in the position of the forehead and eyebrows.

The representative surgery performed in such cases is endoscopic forehead lifting.

• What Is Endoscopic Forehead Lifting? -

Forehead lifting is a procedure that uses an endoscope to sufficiently release the periosteum (the membrane covering the bone) and retaining ligaments around the forehead and eyebrows,

then lifts and fixes the tissues upward.

The following effects may be expected:

• Elevation of drooping eyebrows

• Improvement of sagging eyelid skin

• Reduction of forehead wrinkles

• Improvement of glabellar wrinkles

• Reduction of wrinkles on the bridge of the nose

• Creating a brighter and softer appearance

• What Is Most Important in Forehead Lifting? -

There are factors that have the greatest impact on the results of endoscopic forehead lifting.

They are:

• Sufficient release

• Appropriate release of the retaining ligaments

• Precise treatment of the muscles in the glabellar area

If the structures pulling the forehead and eyebrows downward are not sufficiently released, it can be difficult to achieve the desired lifting effect no matter how firmly the tissues are fixed.

Therefore, the key to forehead lifting lies in making the tissues free to move.

• Various Fixation Methods Used in Endoscopic Forehead Lifting -

After sufficient release has been performed, the lifted tissues must be fixed to maintain them securely.

Representative methods include using an absorbable fixation pin called Endotine and the bone-tunneling method, which involves making small holes in the bone and using sutures for fixation.

Representative fixation methods for endoscopic forehead lifting: bone-tunneling fixation and Endotine fixation. Differences between Endotine and bone-tunneling fixation in forehead lifting

Endotine fixation

: This method uses a special absorbable fixation device called Endotine to fix the forehead tissue to the bone.

Advantages

• Provides consistent fixation strength

• The surgical process is relatively standardized

Disadvantages

• A foreign-body sensation may occur for a certain period

• Although the material is absorbable, it may be palpable depending on the individual's constitution

Bone-tunneling suture fixation

: This method creates small tunnels in the skull and uses sutures to fix the tissue.

Advantages

• No separate fixation device is required

• The use of foreign materials can be minimized

Disadvantages

• Results may vary depending on the surgeon's experience and skill

• Careful experience is needed to adjust the tension

As such, each method has its own advantages and disadvantages, and based on the medical evidence available to date, it is difficult to conclude that one particular method is absolutely superior.

• Features of Penta-Fix Forehead Lifting -

Penta-Fix forehead lifting does not rely on just one fixation method.

Forehead-lifting fixation methods: Endotine fixation, bone-tunneling fixation, and fascial fixation. Source: Aesthetic Surgery Journal, Plastic and Reconstructive Surgery.

In the skull area, Endotine and bone-tunneling suture fixation are used together,

while in the temporal area, a combined fixation method is applied, fixing the tissue to the strong temporalis fascia.

In other words, the lifted forehead flap is fixed at multiple points to distribute the load.

Endotine and bone-tunneling in forehead lifting. Penta-Fix forehead lifting trademark registration with the Korean Intellectual Property Office. Combined fixation in forehead lifting. Differences between Endotine and bone-tunneling fixation in forehead lifting

• Why Fix the Tissue at Multiple Points? -

After forehead lifting, the tissues exert a force that attempts to return them to their original position.

If tension is concentrated at just one specific point, some areas may sag over time, or the shape of the eyebrows may become asymmetrical.

By contrast, balanced fixation at multiple locations may offer the following advantages.

1. Distributing tension

Because the lifted tissues are supported at multiple points, excessive force is not concentrated in a specific area.

2. Stable holding strength

The greater the number of fixation points, the more they can help maintain the tissues securely.

3. Adjusting the eyebrow shape

The degree of lifting on the medial and lateral sides can be adjusted according to each individual's facial shape and eyebrow form, allowing for a more natural result.

4. Natural improvement in appearance

Rather than simply raising the eyebrows, it becomes possible to perform a lift that considers the balance of the entire face.

Before and after endoscopic forehead lifting. Endoscopic forehead-lifting review. Before and after forehead lifting. Forehead-lifting review. Images of a partial model published with consent.

• The Surgical Principles Matter More Than the Fixation Material -

Patients often ask, “Is Endotine better?” or “Is suture fixation better?”

However, the actual surgical outcome is not determined by the type of fixation material alone.

Satisfactory results require a combination of sufficient release and release of the retaining ligaments, precise treatment of the glabellar muscles, appropriate tension adjustment, and stable fixation.

Penta-Fix forehead lifting focuses on distributing tension and adjusting the shape and position of the eyebrows more precisely by using various fixation methods in the appropriate locations.

Because the degree of sagging and anatomical structure differ from patient to patient, it is especially important to establish a surgical plan suited to the individual through sufficient consultation and an accurate diagnosis.

Forehead-lifting review. Three months after forehead lifting. Forehead lifting in a patient in their 60s. Images of a partial model published with consent.

If you would like to learn more about the extent of release, which is one of the most important aspects of forehead lifting, please see the blog post below.