Before your procedure, you’ll be given either general anesthesia or local anesthesia with IV sedation, so you’ll be either completely asleep or very drowsy and relaxed.
Your surgeon will use one of several different brow lift techniques, depending on your facial anatomy and goals. All types of brow lift procedures start with incisions, although their size and location varies.
“The presence of deep horizontal forehead lines, the thickness of the brows, the amount of brow asymmetry, the height of the forehead, the position of the hairline, the hair color and density, and the patient's typical hairstyle are all factors that play in to determining the best technique for each individual patient,” says Dr. Matthew Richardson, a facial plastic surgeon in Frisco, Texas.
Endoscopic brow lifts
This minimally invasive technique was developed in the 1990s. Your surgeon will:
- Make four to five incisions, each about three-quarters of an inch long, just behind your hairline.
- Gently separate the skin from the underlying tissue.
- Insert a long, thin tube with a tiny camera and a powerful light on the end (the endoscope) through one of the incisions, to view the area.
- Use a thin surgical instrument, inserted through the other incisions, to lift and smooth your skin.
- Anchor your skin in its lifted position with staples or sutures.
- Use sutures (usually with dissolvable thread) to close the incisions.
- Apply a dressing or bandage.
Pros: The healing time for an endoscopic procedure is generally shorter than with a coronal or open approach, and it usually causes less numbness across the top of the scalp than other procedures.
Cons: It doesn’t effectively treat horizontal wrinkles in the forehead, it raises the hairline, and it can’t fix very asymmetrical eyebrows, according to Dr. Portuese. It’s also not the right procedure for patients with extensive skin laxity, because no skin is removed. The amount of lifting achieved is more limited than with an open approach.
Open or coronal brow lifts
Also called a classic or open brow lift, this technique was developed in the 1980s. During this procedure, the surgeon will:
- Make one long incision that runs along the top of your scalp, just above your hairline, from ear to ear.
- Lift the tissues and skin, trimming off the excess tissue.
- Secure the lifted, smoothed skin to the scalp with internal sutures.
- Close the incision with more tiny sutures or surgical glue.
This procedure fell out of favor once endoscopic lifts became available, but Dr. Portuese says that doctors are starting to use it more again.
Pros: “The coronal brow lift is a better method for adjusting asymmetry of the eyebrows and adjusting the hairline upward or downward, to either shorten or lengthen the forehead,” according to Dr. Portuese. It’s also a better approach for correcting deep horizontal lines, as well as creases between the eyebrows.
Cons: It requires a larger incision than the endoscopic approach (although it's hidden in the hair). There's also a slim possibility of permanent numbness in the scalp.
Hairline brow lifts
This technique is an option for patients with a high or receding hairline.
The surgeon makes an incision just below the hairline and removes excess skin and tissue from the top of the forehead (rather than the scalp).
Pros: It doesn't pull back the hairline and may even slightly lower it.
Cons: There's a higher risk of a visible scar than with more popular techniques. This method also has the highest rate of revision surgery.
Temporal brow lifts
Sometimes called a lateral or limited incision lift, this limited approach lifts only the outer area of your brow.
The incisions are slightly larger than those in an endoscopic procedure (about 1-inch long) and are placed right behind your hairline above each temple, enabling your surgeon to lift just enough tissue to raise the outer edges of your brows.
A temporal brow lift is often performed in conjunction with eyelid surgery. Through the same incisions used for your eye lift, your surgeon can lift the area between your brows and smooth out deep frown lines.
Pros: Recovery time is shorter than with an open lift.
Cons: Results aren’t nearly as dramatic as with other techniques.
Browpexy
This newer procedure is minimally invasive and useful for small lifts. It’s typically done together with an eyelid lift.
Browpexy is done in one of two ways:
- In an internal browpexy, the surgeon makes a very small incision in the crease of the upper eyelid, tunnels to the brow bone, and removes excess tissue and a small amount of muscle in order to lift the area.
- In an external browpexy, the incision is made just over the eyebrow, and the surgeon removes excess tissue and muscle. In both procedures, the surgeon then secures the brow in place with sutures. The scar left behind is very small.
Pros: Research finds that browpexy can enhance the effects of upper eyelid surgery in people with a drooping brow, without the high cost and side effects of a more extensive procedure.
Cons: While it raises the brow slightly, it isn’t ideal for people who have significant droopiness, creases, or furrows.
Midbrow and direct lifts
These older approaches can produce large and unsightly scars, so they’re rarely used.
- In the midbrow approach, the surgeon makes incisions in one deep crease on each side of the forehead, above the eyebrows, removing excess skin and lifting the brow.
- A direct lift removes excess skin above the eyebrows, which can leave a visible scar.
Doctors typically reserve these two approaches for people who have very uneven eyebrows due to an injury or facial paralysis.
Pros: These techniques can be beneficial for bald men or people with a very high hairline, where it wouldn't be possible to hide the incision in the hair.
Cons: As we mentioned, the scars can be large and visible.
Whatever technique your surgeon uses, the procedure itself shouldn't take more than two hours.
You’ll be able to go home after a brief time in the recovery room. Make sure you have someone you trust there to take you home, since you’ll still be groggy from the anesthesia.
Related: When Is It Time to Quit Toxins and Get a Brow Lift?
