A brow lift returns the eyebrow to its height and its shape, and along the way relaxes the lines of the forehead and between the brows. It does not work on the eyelid: it works on what sits above it.
Over the years the eyebrow descends, and as it does it pushes down the skin of the upper eyelid. The result is a gaze that looks tired, more closed, sometimes with a permanently cross expression without the person being cross at all. It is a change that settles in so slowly that almost nobody connects it with the eyebrow.
Hence the most frequent confusion in this area: whoever comes in about it usually asks for eyelid surgery. And removing eyelid skin when it is the brow that has dropped gives a result that falls short, and in some cases leaves the eyelid tight and the brow even lower. Telling one case from the other is the most important part of the consultation, not of the surgery.
It usually helps when there is
- The tail of the eyebrow has dropped and the gaze looks fallen on the outer side.
- Lifting the brow with a finger visibly improves the look of the eye.
- Marked forehead lines from the constant effort of raising the brow.
- Deep furrows between the brows that no longer respond to botulinum toxin.
- A previous blepharoplasty with a result that fell short.
Worth discussing first if
- A forehead that is already high: some techniques lengthen it further and others do not.
- Hair loss or a marked receding hairline, which determine where the incision can go.
- Expecting a very raised brow: the permanently surprised look is the classic mistake of this surgery.
- Current smoking, which compromises healing of the scalp.
- Problems closing the eyelids or significant dry eye.
None of these rules the procedure out on its own; all of them change the conversation.
Three ways to reach the same layer
The choice depends on the height of your forehead, on your hairline and on how much has to be raised. It is decided in the consultation, not before.
Endoscopic
Through small incisions hidden in the scalp, with a camera. Minimal scars and a faster recovery; it is the usual route when the descent is moderate.
Open or coronal
A longer incision hidden in the hair. It allows the greatest correction and more control when working on the muscle between the brows. Reserved for marked descent.
Temporal, or brow-tail lift
Raises only the outer third, which is the part that usually drops first. It is the most limited option and also the one with the shortest recovery.
Lifting is not tightening the skin
A brow lift is not done by stretching the skin of the forehead: it is done by releasing the deep plane, repositioning the brow as a whole and fixing it at its new height. Pulling on the skin leaves a smooth, shiny forehead, a displaced hairline and a result that drops within a few months.
The other point is shape. An eyebrow should not end up higher, it should end up better placed: the tail somewhat above the head of the brow, with the curve where it belongs. Raising the inner part is what produces that surprised face that gives the surgery away from across a room, and it is a mistake avoided in the design, not afterwards.
It is often combined with an upper blepharoplasty, but in that order: first where the brow will sit is decided, and only then is it worked out how much eyelid skin is really in excess. Doing it the other way round is what produces tight eyelids.
What the process is like
From the first consultation to discharge, with the usual timings for this procedure.
Consultation and diagnosis
The height of the brow, the forehead, the hairline and the eyelid are examined together, and the manual lifting manoeuvre is done so that you can see for yourself how much of the problem is the eyebrow.
Before surgery
Laboratory tests, anaesthetic assessment and stopping smoking and any medication that encourages bleeding. The informed consent is signed.
Surgery
In theatre, as a day case. The design is marked with you awake and sitting up, because the position of the eyebrow changes on lying down.
Follow-up
Stitches or clips out at around day seven to ten, and reviews at one month, three months and a year.
Week by week
The forehead settles before the area around the eyes, which is where the swelling drains to by gravity.
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Days 1 to 3
Swelling of the forehead and eyelids, and frequently bruising around the eyes. Rest with the head raised and cold locally.
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Days 4 to 10
The swelling clearly subsides. There may be numbness and itching of the scalp behind the incision: that is expected, and it eases over weeks or months.
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Weeks 2 to 4
Normal social life. Gentle exercise is resumed at around the third week and intense exercise at the fourth or fifth, subject to review.
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Months 3 to 6
The brow finishes settling. It is normal for it to look somewhat higher in the first weeks than it will end up: the result is judged at three months.
Risks, and what is not promised
The general risks of any surgery — bleeding, infection, healing problems, anaesthetic risks — and those specific to this area: numbness of the scalp, which can take months to recover and sometimes does not recover completely; hair loss around the incision; asymmetry between one brow and the other, which may need an adjustment.
Less frequent but possible is injury to the frontal branch of the facial nerve, which causes difficulty raising one eyebrow. It is usually temporary; in isolated cases it is permanent. It is the reason why the plane of dissection matters so much in this surgery.
No particular result is promised: the final height depends on your anatomy and on how you heal. These risks are reduced by a sound indication and a correct technique. They are not eliminated. The ones that apply to your case are explained to you in the consultation and are set down in writing in the informed consent you sign before surgery.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about brow lifts
There is a simple manoeuvre you can do in front of the mirror: put your finger on the tail of the eyebrow and lift it a centimetre. If the look of the eye clearly improves and the "excess" eyelid almost disappears, a good part of the problem is the brow.
Even so, the assessment in the consultation measures other things — the distance between the brow and the edge of the eyelid, the height of the forehead, the function of the levator muscle — and often the answer is that there is some of both.
That result comes from raising the inner part of the eyebrow, not the tail. The correct design raises mainly the outer third and respects the head of the brow, which is what keeps the expression natural.
In the first weeks the brow looks higher because of the swelling and the recent fixation. By three months it has come down to its final position.
With the endoscopic approach they are incisions of one to two centimetres inside the scalp, hidden by the hair. With the open approach the incision is longer but also goes in the hair.
If you have a marked receding hairline or very fine hair, a different incision is considered, in front of the hairline, which is disguised another way. It is one of the things that determine the choice of technique.
With mild descent, well-placed toxin lifts the tail of the brow by a few millimetres and is a reasonable alternative. It is the first thing proposed when the case allows it.
When the descent is already a matter of centimetres, toxin does not reach that far. Persisting with injectables there is spending money every six months on a result nobody sees.
It is a durable operation, with results that hold for many years, but it does not stop ageing: the brow will go on descending from its new position, only starting from higher up.
How long it lasts depends on the quality of your skin, on genetics, on sun and on smoking.
Question not answered here? There are more answers in the frequently asked questions.
