- Procedure time
- 45 minutes to 90 minutesDepends on the approach
- Anesthesia
- IV sedationNo breathing tube
- Setting
- Our procedure suiteHome the same day
- Downtime
- About ten daysBruising can settle around the eyes
- Results last
- Five to ten yearsLonger in younger patients
What a descended brow does
The brow sits at the top of a chain. When it drops, everything below it is affected: the upper lid appears heavier, the eye appears smaller, and the resting expression shifts toward tired or stern.
People often ask for eyelid surgery when what has actually moved is the brow above it.
Height is not the goal — position is
The recognizable failure of this operation is over-elevation, especially at the inner brow, which produces a permanently startled expression. The aim is to return the brow to where it used to sit and to preserve its natural shape and arch.
Done correctly, nobody identifies a brow lift. They notice that the eyes look open and the face looks less tired.
The work is release, not lift
The name of this operation is misleading. Most of what makes it work is releasing the tissues that are holding the brow down: the arcus marginalis, the orbital retaining ligaments, and the muscles between the brows. Once those are freed, the brow can sit where it wants to.
Running through that same territory are nerves and blood vessels that have to be protected. Where the dissection goes near them I use an endoscope, because seeing the structure is how you avoid it.
Freeing what is tethering the brow does more than pulling on it ever will.
Which approach, and why
There is no single brow lift. The approach follows your anatomy and what you want changed.
- Extending the facelift incision up into the hairline, when the goal is only to lift the outer third of the brow and you are already having a deep plane lift.
- An incision hidden in the hair when the brow lift is done on its own. It lets me undermine everything and release the retaining ligaments with the scar entirely concealed.
- Bringing that incision forward toward the hairline in the cases where skin genuinely has to be removed.
- Short vertical incisions toward the center of the forehead, mostly for access, and sometimes for anchoring when the inner brow needs lifting too.
- An incision directly above the eyebrow, or a forehead incision in some men, where that suits the anatomy better.
A full coronal incision is occasionally the right answer. It is not where I start, and I would explain clearly why I was recommending it.
What can go wrong
Bruising around the eyes is the one that surprises people. Gravity carries blood and fluid downward, so even when the work was all at the brow, the color settles around the lower lids. Allow about ten days.
Expecting the wrong thing is the risk I take most seriously here, and it is why I explain the release beforehand. A patient who believes their brows will be visibly higher, when the aim was to relieve the tension holding them down, will be disappointed by a good result. That conversation happens before surgery, not after.
Where the approach uses external incisions, sutures stay in about ten days.
Common questions
- How do I know if I need a brow lift rather than eyelid surgery?
- By where the heaviness originates. If the brow itself has descended, the upper lid is carrying weight that is not its own, and removing lid skin will not fix it — it can even pull the brow lower. Brow position is assessed before any upper eyelid plan is made.
- Will it make me look surprised?
- That look comes from over-elevation, particularly of the medial brow. The goal is to restore the brow to where it sat, not to raise it beyond that. A brow lift done to the right height is not conspicuous.
- Can it be combined with eyelid surgery?
- Frequently, and often it should be. The brow and upper lid are one continuous unit, and treating them together is what keeps the proportions of the upper face correct.
Not sure this is your problem? Looking tired when you are rested
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