Closed-Eye Assessment of Endoscopic Browlift: An AI-Based Analysis of Eyebrow Position.

BACKGROUND: Endoscopic browlift is a common procedure for brow rejuvenation, but concerns persist about potential forehead enlargement, especially in patients with high hairlines or large foreheads. Previous studies measuring outcomes with open eyes may be confounded by frontalis muscle contraction. This study aimed to accurately assess changes in eyebrow position and forehead appearance after endoscopic browlift using closed-eye photographs analyzed with AI to eliminate the influence of frontalis muscle contraction.
METHODS: Closed-eye photographs of 65 patients were analyzed using the SPIGA AI model. Ratios of periorbital height (B)/mid-facial height (A), forehead height (C)/mid-facial height (A), and forehead height (C)/periorbital height (B) were calculated and compared pre- and postoperatively.
RESULTS: The B/A ratio increased significantly (P<0.001), indicating successful brow elevation. The C/A ratio decreased significantly in the short-term cohort (P<0.001) but showed no significant difference in the long-term cohort. The C/B ratio decreased significantly in both cohorts (P<0.001), indicating a greater relative increase in periorbital height compared to the forehead height.
CONCLUSIONS: Endoscopic browlift effectively improves periorbital aesthetics without significant forehead enlargement. Closed-eye AI analysis provides a more accurate assessment by excluding frontalis muscle influence.
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 .