Endoscopic Facelift with Isolation of the Fronto-Temporal Facial Nerve Branches: A Clinical Study of 300 Cases

Abstract Background Preserving the fronto-temporal branches of the facial nerve (CN VII) is the principal technical challenge in endoscopic facelift, and complete mid- and lower-face mobilization requires release of McGregor's patch. Objectives To evaluate endoscopic facelift when the fronto-temporal branches are systematically identified and completely isolated, allowing release of McGregor's patch. Methods Retrospective study of 300 consecutive patients operated by a single surgeon between May 2021 and August 2024, all with complete circumferential endoscopic isolation of the fronto-temporal branches. Recovery was dated from when the patient noticed the return of voluntary movement of the affected frontalis. Patients not recovered by day 14 received contralateral botulinum toxin for symmetry. Results No permanent nerve injury occurred. Transient frontalis weakness occurred in all 300 patients (100%) and resolved completely: an expected consequence of deliberate nerve isolation, not a marker of technical success. Median time to recovery was 14 days (62.3% by day 14; 95% CI 56.9-67.8), unchanged when patients were censored at toxin exposure. Cumulative recovery was 75.3% at 1 month, 87.0% at 3 months and 94.3% at 6 months; recorded dates are upper bounds. Of the 300 patients, 282 (94%) attended the 12-month visit and 265 (94%) rated their outcome good or excellent. Haematoma occurred in 2 (0.7%) and asymmetry requiring revision in 4 (1.3%). Conclusions Complete circumferential isolation of the fronto-temporal branches was reproducible and caused no permanent injury, at the cost of universal transient frontalis weakness. An uncontrolled series cannot establish that this trade-off is justified; prospective controlled comparison is required.