BACKGROUND: Currently, there are many well-described surgical approaches to address brow aesthetics (i.e., open versus endoscopic versus combination techniques). Each technique has associated benefits and limitations. The authors' discussion in this article is intended to review current worldwide surgical approaches to brow aesthetics and to explore the following question: Are open brow lifts still pertinent in the modern era of cosmetic surgery? METHODS: A systematic review of current available literature for the dates 1992 until the present was performed using the MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and CINAWL databases. Inclusion criteria required that individual studies contain original content; provide patient outcome data, including complications; and maintain a sufficient sample size of no fewer than 20 patients. RESULTS: One hundred eighty-nine articles were reviewed from the initial keyword searches of four major databases and plastic surgery journals. Fifteen articles were included in the analysis after careful review established that the necessary criteria were met. From direct analysis of these articles, no clear evidence exists to indicate that open methods of brow surgery are inferior to endoscopic approaches. CONCLUSIONS: Brow-lift surgery has clearly evolved since the inception of endoscopic techniques in the early 1990s. However, currently there are no prospective randomized trials in the literature that compare the surgical outcomes of differing approaches. This thorough review of current worldwide English-language literature highlights the relative paucity of good comparative studies and serves as a reminder that there is still an important role for the open approach to brow aesthetic dilemmas.
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