Techniques
The three operationsWhat the operation actually is.
Three operations, filmed and written out in the order a consultation takes them: what is done, whom it suits, what it will not do, and what the record behind it says.
- In one line
- Three operations, each reached through one temporal or scalp passage: endoscopic forehead lift, endoscopic malar reduction, and revision rhinoplasty.
- Whom it suits
- Faces where the cause has been separated from the symptom — a brow that has descended rather than an eyelid, a cheekbone whose prominence is bone rather than descent, a nose whose remaining tissue will carry another operation.
- Whom it does not
- A large bony movement needing rigid fixation, an eyelid problem a brow operation will not answer, or a nose still inflamed from the last operation.
- What this rests on
- Plastic and Reconstructive Surgery 2003 (32 cases, PMID 12496619) · Archives of Aesthetic Plastic Surgery 2013 (11 revisions) · Journal of Stomatology, Oral and Maxillofacial Surgery 2021 (261 cases, PMID 32810601).
Written and medically reviewed by Dr. Jung Su Lee, M.D., Ph.D., board-certified plastic surgeon · Last checked 13 September 2026
Axis 01 · since 1999Endoscopic forehead lift
The brow is lifted from inside the scalp, through incisions that stay in the hair. The eyelid is not the first place we look.
Clinic film, 27 seconds. Korean, carrying the Korean Medical Association advertising-review number on screen.
What is done
Five small incisions are made inside the hairline — two in the temporal area, two above the lateral third of the brow, one at the midline. The dissection runs in the subgaleal and subperiosteal planes across the forehead, forward to the supraorbital rim and laterally to the orbit and the zygomatic body. The periosteum over the rim is released, and under the endoscope the corrugator, procerus and the medial head of the orbicularis — the muscles that pull the brow down — are seen directly before anything is adjusted. The brow is then repositioned and held while it heals; the frontalis — the muscle the patient has been using to hold the brow up — is preserved as a rule, and adjusted only where it must be.
Whom it suits
Eyes that feel heavy because the brow has descended, especially when the patient has learned to lift with the forehead and has the horizontal lines to show for it. It is the operation for the brow. Where the eyelid skin itself is the excess, or where the levator is weak, the answer is an eyelid operation instead, or before.
What it will not do
It does not lower the hairline. Lifting the brow can raise the forehead a little, and a patient who wants a shorter forehead needs the opposite operation — forehead reduction through a pretrichial incision. The two are different operations and are not interchangeable. It does not remove excess eyelid skin, and it does not correct ptosis.
Afterwards
Swelling settles over the first weeks. Numbness across the scalp and forehead is usual at the start, and sensation returns gradually over months rather than days. Sensation coming back slowly is expected; it is not a complication in itself. The scars sit inside the hair. Washing and colouring the hair are restricted for a period that is explained at discharge, and the first weeks are not the time to judge the result.
What can go wrong
The frontal branch of the facial nerve — the one that lifts the brow — runs in the territory this operation crosses, which is why the plane is chosen before the incision. Injury to it weakens the lift on one side. It is usually temporary and recovers over weeks to months; lasting weakness is uncommon but it is the complication that matters most, and it is the reason the dissection stays deep to the layer the nerve travels in.
The sensory nerves to the scalp and forehead are stretched or divided at the rim, so numbness and an odd, tight feeling are usual at the start. Most of it returns over months; a patch of permanent numbness behind an incision is possible.
Hair around the incisions can thin. Some shedding after any scalp surgery is temporary and grows back; permanent loss along the scar line is less common but does happen, and it is worse in hair that was already thinning. One of the reviews on this site says so in the patient’s own words.
The two brows can end at slightly different heights. The brow can also settle back over months or years — how much depends on the fixation, the tissue and the weight above it — and a second operation is sometimes asked for. Bleeding under the scalp, infection, and a scar that widens are the usual surgical risks and are uncommon here.
The first weeks, in order
Swelling and bruising are at their worst on the second and third days and are mostly gone by the end of the second week; bruising can track down into the eyelids. Stitches or staples come out at about a week. Most patients are willing to be seen in public at around two weeks, with hair arranged over the incisions. Hair washing is allowed early and colouring is not; the interval is given at discharge. The brow keeps settling for months, so the height at two weeks is not the result.
Forehead reduction, 641 cases Shortening foreheadplasty, 115 patientsThe full explanation, 4 minutes 6 seconds, with Dr. Lee to camera. Korean, with Korean captions.
Axis 02 · reported 2003, 2013, 2021Endoscopic malar reduction
One incision inside the temporal hairline. Two dissection planes from it — one to the arch, one to the body — and no cut inside the mouth.
Animation, 2 minutes 23 seconds: the temporal approach, the two osteotomies and the J-saw. Korean captions.
What is done
Through an incision of about three centimetres behind the temporal hairline, the temporoparietal fascia and the superficial layer of the deep temporal fascia are separated under the endoscope, and the periosteum over the zygomatic body is elevated. The body is cut incompletely — the goal set in the 2012 congress abstract is ninety to ninety-five per cent — so that the fracture that completes it is a controlled greenstick rather than a free fragment. The arch is then cut completely and obliquely from the inner to the outer cortex with a reciprocating saw carrying a J-shaped blade, and the segment is infractured by hand so that the cut surfaces overlap in a Z.
The L-rotation
In the 261 cases reported in 2021, part of the cortical connection is deliberately left in place and becomes the axis the body rotates around, rather than freeing the fragment entirely and moving it a long way with plates. It is not less surgery: it is a decision about what to leave, so that stability and movement are both kept. It also brought the anterior zygoma — which the first method did not handle well — within range.
Whom it suits
The textbook that sets this out under Dr. Lee's name gives three criteria: a prominent zygomatic arch with a normal zygomatic body, a wish to reduce the lateral prominence rather than the whole cheekbone, and a preference for a less invasive route. Where a large movement or rigid fixation is needed, an intraoral approach with plate fixation may suit the face better, and that is said first.
What the record also says
In the 2012 series of twenty patients the body osteotomy went through completely in one case; the instability of the fragment was managed with taping for three weeks, and the abstract records it. The case counts of the three papers — thirty-two in 2003, eleven revisions in 2013, two hundred and sixty-one in 2021 — are separate studies and are not added together.
What can go wrong
The bone is cut and moved, so it has to heal in the position it was set in. It can fail to unite, or unite in the wrong place; both are uncommon and both are treated, and a non-union has to be confirmed on imaging rather than assumed from a lump that can be felt. Impact to the cheek in the first months is what puts it at risk.
The approach is the same temporal route as the forehead operation, so the frontal branch of the facial nerve is again the structure to respect. Sensory branches over the cheek are commonly dulled for a period and usually recover.
Narrowing the bony support can let the soft tissue of the cheek descend, which is the reason this operation is not offered to every face and why what remains matters as much as what is removed. The two sides can end slightly different, and taking too much is as real a fault as taking too little — a cheekbone reduced past what the face carries reads as hollow rather than narrow.
Bleeding, a collection under the flap, and infection are the usual surgical risks. A step or an edge that can be felt through the skin is possible where the cut surfaces overlap.
The first weeks, in order
Swelling is at its worst on the second to fourth day and a compressive dressing is worn early. Chewing is restricted at first and the diet is soft. Most patients are willing to be seen in public at about two weeks, with swelling still visible to themselves for longer. The bone consolidates over months: contact sport, and anything that risks a blow to the cheek, waits for the interval given at discharge.
One incision, two planes · 2003 L-rotation · 2021 Revision · 2013 Axis 03 · what remainsRevision rhinoplasty and foreign-body removal
Whether another operation is possible is decided by the tissue that is left, not by the number of operations before it.
No film for this axis: what it involves differs so much between faces that a single film would mislead.
The seven checks
Before a plan is made, seven things are separated: how much septal and ear cartilage remains; the thickness of the skin, its blood supply and its scars; what materials were used before; whether inflammation has settled and how long it is since the last operation; the degree of contracture and shortening; the airway; and whether rib cartilage or dermis will be needed. A face that has been opened before is a different problem from one opened for the first time.
What patients arrive with
A septum that has given way years after the first operation, and needs rebuilding rather than reducing. An implant set too high and removed, leaving a tip that turns up. Inflammation that has not settled, where the right answer is time before surgery. Cartilage already taken from the ear, which changes what is available and means the donor site has its own cost. Each is a different problem and each is named before anything is proposed.
Material that will not come out
Filler, fat or threads injected elsewhere sometimes cannot be removed by a non-incisional method. Through small scalp incisions, subperiosteal dissection and capsulotomy, material can be taken out under direct endoscopic view, with the temple and cheek reached through a second approach where needed — the case reported from the clinic at PRS Korea 2020. The endoscope is used because it shows the material and the structures around it at the same time.
What is said first
Sometimes the answer is not to operate now. Where the findings say that waiting, or not operating at all, is the better course, that is said before anything else.
What can go wrong
A nose that has been operated on before carries more risk than one that has not, and the more operations it has had the more that is true. Infection is more likely in scarred tissue, and in the worst case it costs the graft. The skin itself can be thin or poorly supplied after repeated surgery; where it is, the operation is smaller than the patient wants it to be, and that is said before rather than after.
Cartilage taken from the septum, the ear or the rib can be absorbed, shift, or warp as it settles, and rib cartilage in particular can bend over the first year. Taking rib leaves a scar at the donor site, soreness for some weeks, and — rarely — air in the chest cavity, which is looked for before you leave.
Contracture can return. A revision does not guarantee that a further revision will never be needed, and any surgeon who says otherwise about a nose with a history is not describing this operation.
Breathing does not always improve, and where the functional problem lies outside what this operation addresses that is said at consultation. Changes in the sense of smell are usually temporary.
The first weeks, in order
A splint is worn for about a week. Bruising around the eyes is usual and fades over one to two weeks. Swelling of the tip is the slowest part: six to twelve months in a first operation, and longer in a nose that has been operated on several times. The shape at one month is not the shape at one year, which is why the films on this site show the same case at one month and at ten.
What can go wrong
Not all of it always comes out. Material that has spread through tissue, or that has been in place for years, leaves a boundary that cannot always be found, and where that is the case it is said in the operative record rather than glossed over.
Removing material and the scar around it can leave a depression or an irregular contour where there was a lump. Restoring that is a separate question and sometimes a separate operation.
The planes in a face that has had injections are not where they were, so nerves lie in places the anatomy does not predict; the forehead, glabella and temple are dense with them. Bleeding and infection are the usual surgical risks.
More than one operation is sometimes needed. Where the material has provoked a persistent inflammatory response, settling can take months after the last of it is out.
The first weeks, in order
Swelling and bruising settle over one to two weeks. The contour is not judged until the inflammation has gone, which is months rather than weeks; a contour that looks uneven at three weeks is usually still moving.
Secondary tip plasty after PCL mesh · 2022 Questions patients ask Explained on filmThe two questions a revision always raises
When it should be done, and what happens afterwards — set out by the clinic on film rather than in a brochure. Korean, with the substance of each written out underneath in English.
When a revision should be done — and when it should not
Watch the filmhttps://vimeo.com/176707749/e63fdc1b3a
Care after rhinoplasty
Watch the filmhttps://vimeo.com/175652084/696cce4668
Cases, at one month and at ten
Vertical films the clinic publishes on its own channels, each following one face from before surgery through the months after it. Korean captions; the procedures are named in English under each.
Individual cases, published with the patients' consent. Results differ between individuals, and the notice carried on each film says so; nothing here is a prediction of an outcome. Films are from the clinic's channel and are not attributed to one surgeon unless the film says so.
Every plan begins with the layer.
Consultations begin with examination and 3D CT, and ultrasound where needed. Surgical information on this page reflects the clinic's own explanations; results vary by individual, and all surgery carries the possibility of side effects and complications.
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