My Doc Suggested Brow Crease to Brow Crease Removal For My Lift- What Are Your Thoughts On This Method?

Since the incision is made along the brow wrinke he said that the wound will be in comression and the scar will not be very noticable. I am nervous about a 5 inch scar in the middle of the forehead....what are your thoughts on this method?

Doctor Answers 9

Browlift via crease incision is NOT recommended!

With due respect to my facial plastic (ENT) and oculoplastic (Ophthalmology) colleagues, I must say that a scar in the middle of your forehead, even if it heals perfectly, is still a scar in the middle of your forehead. And although "hiding the scar in a crease" "sounds" like a reasonable approach, I have been asked to revise all too many of these scars when the result is not what the surgeon OR the patient anticipated. And once placed, you can never decide to "take it back" if what I'm telling you turns out to be true. And, since browlift not only "lifts" the brows but also smooths the forehead expression lines, what once may have been hidden is now MORE visible!

A properly-performed bicoronal incision forehead lift yields NO visible scar (hidden completely in the hair, and BTW, no need to shave the head) and minimal hairline elevation, while also allowing the most precise browlift, elimination or reduction of the frown lines between your brows (by careful removal of the corrugator supercilii and procerus muscle fibers responsible for these actions--a permanent "Botox-like" effect), and often reducing the amount of apparent "excess" upper eyelid skin.

A properly-performed trichophytic (hairline) incision can do all these things with the brows, upper eyelids, and frown muscles as well, but can also lower the anterior hairline in patients with a "high forehead" or too-high hairline. The incision is beveled so that hairs can grow in front of the scar, helping to camouflage it, reducing the potential visibility of this scar. The hairline scar is under the same conditions as the mid-forehead scar (so it should heal at least as good as this approach), but with the ability to conceal this scar location with hairstyles that the mid-forehead scar position does not allow. And, of course, if the scar heals badly, a hairline scar can have hair transplants placed to conceal it, whereas the mid-forehead scar cannot!

Complete training in plastic and reconstructive surgery includes craniofacial surgery, and bicoronal and hairline incisions are commonplace and well-studied approaches to reconstructive and cosmetic problems of the forehead and orbital bones and tissues. Cosmetic surgeons of other specialties may have limited training in these incisional approaches, and may recommend a mid-forehead incision not because it is better, but because it is easier or within a certain "comfort zone" of experience or training.

Even though I tried to word my last paragraph carefully, lest I offend my ENT or Ophthalmology-trained colleagues (my sister is an Ophthalmologist), once experience is gained with bicoronal or hairline incision approaches in many patients, the mid-forehead incision approach is no longer recommended! So consider consultation with cosmetic surgeons of different backgrounds before making this decision, and ask to see many photographs of patients with the mid-forehead incision scars before you choose this approach. Best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Midforehead browlift is a common and powerful approach but you need to be aware of the risk of a visible forehead scar

Midforehead browlift is a common and powerful approach but you need to be aware of the risk of a visible forehead scar. This technique is most appropriate for people with deep forehead lines in which the scar can be "hidden." With that said, you still need to find an experienced surgeon as there is no guarantee that this scar will camouflage well. Other technique involve multiple small incision hidden within the scalp hair (endoscopic browlift) or a longer, single incision placed just behind or well behind the hairline.


Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Should I have a incision inside the forehead crease for my Brow Lift?

 Not IMHO.  Placing a scar where it's readilly visible seems silly to me as a plastic and cosmetic surgeon.  I have performed Brow Lifts for well over 20 years and horehead creases are dark because of the shadow their depth causes.  Scars are red, pink or white and never, never look the same as a forehead crease.  Have a second opinion before having scars that will never go away and are in the center of your forehead forever.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Brow crease incision to lift forehead

Personally, I would never recommend an incision in the middle of your forehead. A more aesthetic result would be by placing the incision into the hairline or (if your forehead is too wide already) at the hairline where it would be better hidden. Best wishes, Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

My Doc Suggested Brow Crease to Brow Crease Removal For My Lift- What Are Your Thoughts On This Method?

Be sure you understand the risks/benefit ratios before having this "mid brow lift". There could be a permanent scar. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Mid-forehead Brow Lift

When done properly, the incision from a mid-forehead brow lift heals beautifully and is not noticable.  Here is the problem with the advice that you were given.  The aesthetics of the brow determine where the incisions are made, not  the location of the forehead wrinkles.  To arbitrarily make incisions based on wrinkles is a recipe for aesthetic disaster.  My recommendation would be to get a second opinion.  Brow lift surgery is like sculpting, the goal is to change the shape and position of the brow to optimize the appearance of the eye.  Find a plastic surgeon that has this mind set and you will be happy.

Joseph Campanelli, MD
Portland Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Photos would be helpful

There are at least 5 different techniques used for browlift surgery, and each might fit a particular patient better than others.

With someone with deep forehead creases, a midforehead incision might be a very good way to address a droopy brow. Hair density and the hairline position are also factors to consider.

Posting photos of yourself might be a good way for us to give you a better idea of what technique might serve you best.

Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Midforehead lift

It would be useful to post some pictures or provide some details about yourself.  

For example, this type of brow lift may be a good idea if you are:

  • a man
  • >60 years old
  • bald or with thinning hair
  • have deep horizontal wrinkles

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Brow crease incision

  I think this is a wonderful and well accepted way to elevate the center of the forehead and the central brows as long as you are not very concerned about the possibility of a visible incision.  Otherwise, other techniques, perhaps more costly, could be used.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 131 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.