Should I get a brow lift or permanent eyebrows first?

Question

I had an upper eyelid lift about 12 years ago. I went for a consultation, and the surgeon said the skin above my eye is too thin,so I can't have another upper eye lift. He suggested a direct brow lift, where the incision is made in my eyebrow, or directly above. The stitches disappear in about a year. This is the second surgeon who independently recommended this. Second question. My eyebrows are very light and thin. I was thinking about getting permanent eyebrows done. Which should be done first?

Toby Mayer, MD · Answer

The Irregular Trichophytic Forehead Lift is what would be best. The hair grows they the scar and the scar does not show. Also, your hairline is not raised which it is when the incision is made behind the hairline. See an experienced surgeon familiar with this technique which we developed 35 years ago.

Robert W. Kessler, MD, FACS · Answer

This procedure is ideal for a small subset of people due to the possibility of a permanently visible scar which is often difficult to hide.

	A more traditional approach would be an open or endoscopic brow lift. The incisions are in the hair and not visible. These techniques will also address the skin excess of the entire forehead not just the brow position.
	Seek out a board certified plastic surgeon to discuss all of your options. I hope this was helpful.

Stephen Weber MD, FACS · Answer

A direct browlift is a great procedure in specific patients. There are often better ways to perform a browlift procedure which almost immediately camouflage the incision. The downside to the direct browlift is that the scars can be objectionable for a year. As Dr. Kabaker suggested you might want to have permanent makeup performed after the procedure at which point the scars can also be tattooed to help with camouflage.
	Both endoscopic and open browlifts provide very nice results without the need to coverup the incisions for up to 12 months. I recommend you seek a third opinion and ask specifically about options other than the direct or midforehead approaches. I hope this information is helpful.Stephen Weber MD, FACS

William Portuese, MD · Answer

The direct browlift is an older procedure that was popular 20 to 30 years ago. It is not commonly performed today. It is usually only preformed today for a unilateral brow ptosis in a unilateral facial nerve paralysis. When a bilateral brow lift is needed, an endoscopic or coronal approach is used to raise the entire forehead. The browlift also adjusts muscles of the forehead including the frontalis, corrugator, and procerus muscles when needed at the same time.

Norman Bakshandeh Day, MD, FACS · Answer

A direct excision for a lift is appropriate for certain patients. I would get the tatoo after the surgery is complete

Michael Law, MD · Answer

If there is a facial rejuvenation surgery that is over-recommended and often overdone these days, it is without question the browlift. Look no further than the celebrity photo magazines for pictures of stars who look like they have just sat down on a plate of tacks. The goal of aesthetic plastic surgery should be to make a person look better and more youthful, not merely different, and certainly not as though one is perpetually surprised. My goal is to provide my patients with results which appear natural, and an unnatural-appearing brow is a dead giveaway that a person has had facial plastic surgery.

	I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead – if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious.

	A youthful, feminine brow rests above the level of the orbital rim, which is the upper margin of the bony socket in which the eye resides. An aesthetically pleasing brow is somewhat arched laterally, and the lateral end or "tail" of the brow is higher than the medial end. It is quite common for the female brow to assume an essentially flat or horizontal orientation as a person ages.

Curtis Wong, MD · Answer

vary by who you talk to. The simpletons will suggest the direct browlift as you describe. The technology invested will talk about endoscopic techniques. Then there are those in between. We all have our favorite way of doing things but you should return to your plastic surgeon and ask them about the other ways to accomplish this, including the coronal, subcutaneous, and endoscopic techniques in addition to your direct method. If they don't want to discuss the pros and cons of each, see another doctor who can fully inform you so that you can make the best choice for yourself.

Barry L. Eppley, MD, DMD · Answer

While you have subnitted no pictures for evaluation, it would be hard to imagine under what circumstances a direct browlift would be the best approach. The direct browlift scar is rarely a good one and if one wants an incision that avoids hairline distortion the pretrichial hairline approach would be far superior. Regardless of the browlift technique, micropigmentation (tattooing) of the eyebrows should be done after the lift.

Kimberly Lee, MD · Answer

It's hard to make a recommendation without evaluating you and the position of your brows and eyelids first. However, I generally perform my browlifts endoscopically to hide scars, but this also depends on your hairline. Please consult with a board certified specialist who can best assist you in achieving the results you seek.

Richard Galitz, MD, FACS (in memoriam) · Answer

25 years ago when I first went into practice I did direct browlifts. They were easy and I was able to talk some patients into it that did not want traditional surgey for forehead or brow drooping. Unfortunately I hated my results. The incision was always visible and unsightly no matter how carefully I did the closure. After a half dozen or so cases I completely dropped the operation from my consideration. Simply stated ....a lousy operation that should never be done. If you have thin eyebrows the best proceedure is an eyebrow transplant which we do in my office and looks great. Your own hair is taken from the back of your head and transplanted to grow permanently and naturally out of your own eyebrows for the rest of your life.

Should I get a brow lift or permanent eyebrows first?

Answers (14)