What a brow lift corrects
When the brow drops, it pushes the upper eyelid skin down. The eyes look tired even when the person is rested, and people tend to compensate without realising by raising their brows, which deepens the horizontal lines on the forehead.
The aim is the proportion that suits each face and each sex, without chasing a set height or a model look. The natural position of the brow is not the same in a man as in a woman.
When it is considered and when it is not
The indication depends on where the problem really lies, and this is what causes most confusion at the first consultation.
When the problem is the brow
If lifting the brow with a finger opens up the eyes and the eyelid no longer looks heavy, the droop comes from the brow. In that case a brow lift is the right procedure.
When the problem is the eyelid
If the brow is in a good position and the excess is skin of the eyelid itself, the indication is blepharoplasty. Raising a brow that is already well placed gives a constantly surprised look that is hard to reverse.
When it is both
This is the most common situation from a certain age: the brow has dropped and there is also excess eyelid skin. The two procedures are planned together and the order matters. The position of the brow is assessed first and then how much eyelid skin is in excess, because lifting the brow corrects part of that excess on its own.
Techniques
The technique is not decided by age or by the patient's preference. It depends on the height of the hairline, the thickness of the forehead skin, the degree of descent and whether the muscles between the brows also need treatment.
Endoscopic brow lift
It is performed through several small incisions behind the hairline, with a camera that allows the surgeon to work under direct vision. The forehead tissues are released and fixed in the planned position. The incisions are in the scalp, with no scar on the forehead.
Temporal or lateral lift
It works only on the tail of the brow, through an incision in the temple area, also inside the hairline. It is more limited and is indicated when the descent is mainly on the outer side and the inner part of the brow is in place. It is often combined with eyelid surgery.
Direct or supraciliary approach
It is reserved for specific cases, mainly men with a receding hairline or patients with facial paralysis, where the other approaches are not viable. The incision runs just above the brow and leaves a scar that the brow hair itself helps to hide, which is why the indication is weighed carefully.
What a brow lift does not treat
- Lower eyelid bags, which are a different problem with their own approach.
- Skin quality and fine lines on the forehead. The horizontal lines soften to the extent that the person stops forcing the expression.
- True eyelid ptosis, a droop of the eyelid itself caused by the levator muscle, which is operated on differently.
- The shape of the brow. It repositions the brow you have.
Recovery
Swelling of the forehead and eyelids is expected in the first days and can spread around the eyes. Keeping the head raised and applying cold as instructed is advised.
Sensation in the scalp is usually altered for weeks or months, with numbness around the incisions, and returns gradually. Physical effort and sun exposure are limited for as long as the surgeon advises. The final position of the brow can be seen once the swelling has fully gone down, which takes a different time for each person.
Risks
They are explained at the consultation before any decision: asymmetry between the two brows, altered sensation in the scalp, hair loss around the incisions, too little or too much lift, and injury to the frontal branch of the facial nerve, which moves the brow. How often each one happens depends on the case and the technique.
Frequently asked questions
How do I know whether I need a brow lift or blepharoplasty?
In front of a mirror, lift your brow with a finger. If your eyes open up and the eyelid no longer looks heavy, the problem is the brow. If the eyelid looks the same, there is excess eyelid skin. This is a guide; the assessment at the consultation decides.
Is there a visible scar?
With the endoscopic and temporal approaches the incisions are behind the hairline and covered by the hair. With the direct approach the scar sits above the brow, which is why it is only considered in selected cases. How it heals depends on each person's skin.
Can botulinum toxin achieve the same?
Toxin can raise the tail of the brow slightly by relaxing the muscles that pull it down. The effect is limited and temporary and it does not reposition the tissues. With a mild descent it may be enough for a while; with a structural one, it is not.
Is it done under general anaesthesia?
It can be done under general anaesthesia or under sedation with local anaesthesia, depending on the technique, the extent and the anaesthetist's assessment. If it is combined with other facial surgery, the overall plan decides.
How long does the result last?
Surgery repositions the tissues, but ageing continues. The tissues keep descending over the years at a pace that depends on genetics, skin quality and lifestyle.
Can it be combined with a facelift?
Yes. A brow lift treats the upper third and the deep plane facelift treats the midface, the lower face and the neck. Combining them is assessed according to the case and the combined recovery.