Anatomy-guided dissection plane selection in endoscopic brow lift: a narrative review of supraperiosteal, subperiosteal, and multiplane approaches.

Endoscopic brow lift has become a widely adopted technique for upper facial rejuvenation due to its minimally invasive nature and favorable aesthetic outcomes. Compared with traditional open approaches, it offers reduced scarring, shorter recovery time, and a lower incidence of sensory complications. Three principal dissection planes are currently employed: the supraperiosteal (subgaleal), subperiosteal, and combined supra-subperiosteal approaches. Each plane differs in anatomical relationships, surgical exposure, biomechanical lifting mechanisms, and risk of neurovascular injury-particularly involving the deep branch of the supraorbital nerve. Recent anatomical and clinical studies suggest that supraorbital nerve tension plays a critical role in limiting brow elevation. Furthermore, considerable anatomical variability exists in the course of the supraorbital nerve, complicating surgical standardization. This review provides a comprehensive comparison of these three approaches, integrating anatomical insights, surgical outcomes, and clinical evidence. Particular emphasis is placed on nerve safety and the rationale for the multiplane approach, which may offer an optimal balance between surgical efficacy and complication avoidance.