Best Surgical Approach to Lower Left Eyebrow?

Is a temporal lift sufficient usually to fix a left eyebrow that's lower than the right? An older doctor said a coronal is needed (though i'd go to someone else who'd do it through endoscopy, if I wanted that. A younger doctor said he'd do a temporal lift through endoscopy? The older doc said temporal lifts don't work that well, but he suggested seeing the younger doc. Track record on temporal lifts?

Doctor Answers 14

Options for lowering asymmetrical eyebrow

You would need a comprehensive approach to lift one side of the brows. This is commonly seen in patients with Bell's Palsy which causes one side to be significantly lower.  Endoscopic or temporal lift should suffice as a first start.

Beverly Hills Facial Plastic Surgeon
4.3 out of 5 stars 9 reviews

Coronal brow lift is where you cut the whole scalp

In general, coronal brow lift is where you cut the whole scalp, peel it and lift it.  This procedure is usually done by older doctors.  It does work.  It will lift the brow up, but it is a very invasive procedure with a lot of downtime and is associated with more complications.  For brow lifting, I prefer endoscopic brow lifting surgery.  It’s a more technically dependent surgery, meaning there’s more technology involved, so a lot of doctors may not have that technology.  But, I think it is a state-of-the-art procedure as far as healing is concerned.  When it comes to brow lifts, the longevity really depends on the doctor and the type of procedure being done.  With all of these procedures, the brows do tend to come down over time.  But, these days, you have to be careful because there are a lot of brow lifting options available.  A lot of times fillers can be used to lift the brow and often I prefer that procedure.  It depends on the patient’s age and need for correction.  I like to do endoscopic brow lifting with a product called Bio Glue because it’s less invasive.  It doesn’t require drilling into the scalp.  And, when you do a coronal brow lift, you’re excising a lot of skin which can lead to the forehead looking longer.  And, with an endoscopic that doesn’t seem to happen as much.  When you use something like Bio Glue, which is a dissolvable adhesive glue, it makes the procedure less invasive in many ways.  But, you need a doctor that is knowledgeable of this type of procedure because this is an off-label use of the product.  Endoscopic brow lifting is often preferred, but it has to be done by someone who knows the equipment.  Older doctors often do not know how to do it.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 66 reviews

Temporal lift works well laterally

Temporal lift works well laterally. It just depends on who is doing the procedure. You have to make sure that the structures that are holding the eyebrow down are release to allow the eyebrow to come up and then fixing it up there is important. The more that your surgeon knows the better. Pictures would be better for me to find out what you are talking about. Fat injections are another way of doing this in a minimally invasive way.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

Best surgical approach to lower eyebrow

Temporal lifts tend to not work as well because you are not addressing the problem.  A temporal lift is only going to lift the lateral portion of the eyebrow and not the entire eyebrow.  If there is that much asymmetry of the eyebrows, a coronal approach is best used to try to balance the asymmetry of the eyebrows.  It is important to also adjust the depressor muscles pulling down the eyebrows to give a symmetrical change.  Endoscopic approaches do not work as well as the open approach when significant asymmetry exists.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Treatment for uneven eyebrows

There are many different surgical approaches to the eyebrow: coronal, trichophytic, direct, midforehead, and coronal are some of the most common methods. One disadvantage of the more traditional approaches, such as coronal and trichophytic, is that the surgeon is trying to manipulate the brow position from a distant incision in the hairline. The endoscopic browlift also can have the same problem. Direct browlifts, where the incision is made directly along the eyebrow, can lead to visible incisions.

I have had a lot of success in treating uneven brows (either from an earlier surgery or from a patient's natural asymmetry) with an approach called the midforehead buttonhole lift. It uses an incision just above the eyebrow hidden in a forehead crease. Because the incision is very close to the eyebrow, it can be very accurate in repositioning the brow. Because it is in a natural crease line, as long as it is sewn together carefully, it heals very well. This approach is not commonly used, but is similar to the temporal lift.

It is definitely important to speak with a surgeon who is experienced in brow asymmetry as this can be a tricky dilemma.

Gregory J. Vipond, MD, FRCSC
Inland Empire Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

Correction of uneven brows

There are several approaches to uneven eyebrows: coronal, endoscopic, transpalpareal (under upper eyelid), subcutaneous, temple lift, that all can achieve the result you are looking for. The chpoice really depends on the aesthetic apperance and the surgeon's personal preference. However, the real question is why you have the problem int he first place. If there is an underlying assymetry of the frontal bone then the likelihood of long term succes is small. The brow will "slide" down again. But it is worth exploring . During consultations you should ask how long after the procedure were post op photos taken. The longer the better. Good luck

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Asymmetric brows

Dear Lulu,

All the discussions from the other doctors about the various brow lifting techniques are thorough and accurate.  However, before taking the step to surgery, the first question should be why do you have asymmetric brows?  Have you had this asymmetry your entire life?  Did you have a Bell's palsy?  Do you have an underlying drooping eyelid on the opposite side?  Do you have a preference for the opposite (higher) brow?  Except in specific circumstances like a Bell's palsy, it is usually not appropriate to just lift one brow.  In fact, in some cases it might even be better to lower the higher side with Botox/Dysport.  I would hope the two physicians who met with you evaluated you thoroughly, and discussed this issue. 

Yoash Enzer, MD

Yoash R. Enzer, MD, FACS
Providence Oculoplastic Surgeon
3.4 out of 5 stars 8 reviews

Techniques to achieve brow symmetry

There are quite a few different techniques that can be utilized to achieve brow symmetry, ranging from a bi-coronal incision to a browpexy, and methods in between.  The least invasive is a browpexy, in which an incision is made in the upper eyelid of the affected side and the brow is released from the underlying tissues.  Sutures can be placed from the brow to above the hair line to suspend the brow in the proper position as it heals.  Absorbable sutures are used so no foreign material is left in the body.  Other techniques can work as well.  Perfect symmetry can be difficult to achieve, though some techniques are more precise than others.

Leif Rogers, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 26 reviews

Brow Lift Surgery Options

Hi Lulu,

Unlike traditional brow lift surgery that involves an incision across the entire forehead, the endoscopic brow lift is a minimally invasive method of lifting the eyebrows. Plastic surgeons perform minimally invasive plastic surgery through very small incisions hidden in the hair & scalp to recreate a youthful appearance. Brow lift surgery lifts and repositions sagging tissue that occurs with natural aging and sun damage.

Endoscopic brow lifts, also called an endobrow, usually takes under an hour.

Benefits of an endobrow, as compared to traditional brow lift surgery:

  • smaller incisions
  • reduced scarring, bruising, bleeding, swelling, numbness
  • faster recovery period

Only after a comprehensive evaluation can a plastic surgeon help determine if an endoscopic brow lift is appropriate for you. Best of luck.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Temporal brow lift is a great way to raise the outer eyebrow

The lateral temporal brow lift is an excellent way to lift the outer part of the eyebrow.  If the inner and outer parts of the eyebrow need to be elevated, then a coronal lift is usually required.

Jeffrey E. Schreiber, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 202 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.