OverviewAs we age, the skin on our foreheads develops wrinkles and furrows and may begin to sag, causing us to look tired or unhappy. A brow lift is a safe and effective way to restore a youthful, rested look. (1) Also known as a forehead lift, a brow lift can elevate drooping eyebrows and smooth deep forehead creases and lines between the eyebrows. A brow lift can be performed simultaneously with eyelid surgery to minimize sagging skin near the eyes or a facelift that can rejuvenate the lower portion of the face.
As we age, sagging skin can make us look angry or worn-out. A brow lift is a safe and effective way to restore a youthful and rested appearance by removing sagging skin and minimizing wrinkles and furrows that appear on the forehead as we age. (2) Brow lifts can specifically treat:
- Forehead wrinkles
- Folding around the eyelids
- Forehead creases
- Sagging skin on the forehead or around the brow line
It is important to be realistic about what a brow lift will change and what it won’t. During your initial consultation with your surgeon, discuss your goals and desired outcomes and ask whether a brow lift will provide the results you want. In some cases, your surgeon may suggest alternative or additional surgeries that will allow you to achieve your desired outcome. Brow lifts are restorative; they will not significantly alter your facial features or structure. Things to keep in mind when you are considering a face lift:
- Don’t be afraid to ask questions during the initial consultation
- Final results may not be apparent for several months after the surgery
- Results of a brow lift are long-lasting but are not permanent
- Numbness around the incision sites could be a long-term side effect
- Hair loss may occur around the incision sites
Most patients who choose a brow lift are seeking to reverse signs of aging such as visible forehead lines and sagging eyebrows. Overactive muscles and heredity can also play a role in the appearance of the forehead. These conditions may make you look fatigued or angry. In this case, you may benefit from a brow lift. A good candidate for brow lift surgery is typically:
- In good overall health
- Between 35 and 60 years old, although adults of any age are possible candidates
- Has some skin elasticity, which helps the body adapt to its new contours
- Realistic about what to expect
You may not be a candidate if you:
- Suffer from medical conditions making you unfit for surgery
- Have unrealistic expectations
- Are mentally unstable
Brow lifts are not an appropriate treatment for crow’s feet or bags under the eyes as the brow lift procedure focuses on the brow line and the facial skin above this line. For this reason, some patients may opt for other cosmetic treatments to treat these conditions such as eyelid surgery or a face lift.
There are several variations of brow lift surgery that vary depending on the location and pattern of the incision. Broadly speaking, brow lifts can be categorized into two general categories, open and endoscopic.
- Open brow lift: (3) Also known as a full coronal brow lift, this method can provide the most substantial change in the appearance of the forehead. The surgeon makes an incision behind the hairline, from one ear to the other. This technique carries the most risk for noticeable scarring, particularly in patients who have hair loss. Consequently, open brow lifts are performed less frequently than the less invasive endoscopic brow lifts, but for people who desire substantial changes in forehead appearance an open brow lift may be the best option.
- Endoscopic brow lift: (4) The technique is performed through a small tube with a camera that allows the surgeon to use a smaller incision line. Typically, the incision is located either within the wrinkles of the forehead or behind the hairline. This method is usually chosen when there is not a lot of excess skin to remove, as this is more difficult to accomplish with the smaller incisions. Endoscopic brow lifts are one of the more popular techniques used today because they are associated with a shorter recovery period, less post-surgery discomfort, and less visible scarring than traditional open brow lifts. Endoscopic brow lift variations include permanent sutures that are used to suspend the muscles and tissues in a higher position of the brow.
Surgical techniques can be tailored to address specific concerns, including lifting sagging brows, shortening the forehead, or correcting folds and small wrinkles on the forehead and at the corners of the eyes. The best procedure and technique for each client will depend on their natural characteristics (including the hairline and degree of brow drooping) and desired outcome. It is important to discuss your goals and desired outcome of the surgery during the consultation in order to be confident that they are achievable and to make sure you undergo the most appropriate procedure.
In some cases, a brow lift may not be the most appropriate surgical option. For example, sagging skin around the eyes and crow’s feet may be better addressed with eyelid surgery. Brow lifts are often performed in conjunction with an upper eyelid surgery or a face lift. Surgical alternatives include:
- Facelift: A facelift tightens loose skin and the underlying muscles of the face
- Eyelid surgery: Known as blepharoplasty, eyelid surgery can address sagging skin and wrinkles in the upper and/or lower eyelid area and minimize undereye bags
There are non-surgical alternatives to brow lift surgery, but these options are frequently most appropriate for younger people or those who do not have substantial wrinkles or sagging skin. Non-surgical options can be combined to achieve specific goals. Non-surgical alternatives include: (5)
- Botox: Botox and similar products temporarily paralyze muscles in your forehead, which releases fine lines, prevents the skin from creasing and wrinkling, and raises the ends of the eyebrows. Botox needs to be repeated every 3-4 months.
- Fillers: Injectable fillers add volume to deflated areas of the brow and temple area, which minimizes the appearance of wrinkles. Options include hyaluronic acid (Restylane, Juvederm), lipofilling, and substances that stimulate collagen production (Sculptra). Fillers can last from several months to a few years.
- Skin tighteners: Non-invasive skin tighteners include ultrasound (Ultherapy), radiofrequency (Thermage), and pulsed (fractional) or continuous CO2 laser resurfacing technology, which stimulate collagen production.
Choosing your surgeon can be daunting, but it is important to spend the time to find the best surgeon for you. Any surgeon you consider should be board-certified and have membership in one or more of the following:
- American Board of Plastic Surgery (ABPS)
- American Society of Plastic Surgeons (ASPS)
- American Society for Aesthetic Plastic Surgery (ASAPS)
- American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)
- American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS)
A membership in any of these societies does not guarantee a successful result, however, in order to achieve board-certification, extensive medical training, experience, and rigorous surgical education are required. A board-certified surgeon will ensure that the most appropriate techniques are used for your brow lift surgery while reducing the risk of complications.
There are some potential risks associated with brow lift surgery that should be discussed with your surgeon beforehand. Some of these include: (3)
- Anesthesia complications
- Nerve damage
- Skin irregularities and discoloration
- Temporary hair loss around area of incision
- Prolonged swelling
- Facial asymmetry
- Dry eye or irritation
- Eyelid disorders
- Possible revision surgery
These risks are minimized when you work with a board-certified cosmetic surgeon. Be sure to speak with your surgeon about all potential risks before moving forward with surgery. While risks are uncommon and may be unforeseeable, side effects are normal, temporary consequences of surgical brow lifts. Common side effects associated with brow lifts include:
In the first week or two following the surgery, side effects can be managed with pain medication, keeping your head elevated, and holding cold compresses on the site as directed by your physician.
The type of brow lift procedure you undergo will play some role in the recovery, as well as the symptoms you can expect. In general, an endoscopic technique is associated with a faster brow lift recovery time and fewer symptoms than an open brow lift. After the procedure, patients must keep their head elevated for several days. This will require sleeping with several pillows behind you. Doing so is essential for a fast brow lift recovery time and to minimize swelling. If your surgical incisions required sutures, they will be removed approximately one to two weeks following your procedure. Although sutures are required for most open brow lift patients, they may not be needed for some endoscopic procedures. Most patients also have surgical gauze, tape, or bandages that must be worn over the forehead and brows for the first few days. The surgeon may also need to place a drain, or small tube, in the surgical site to drain any excess fluid that may accumulate after the surgery. Showering and other daily activities can be resumed within a week of the surgery, but rigorous activities must be avoided for several weeks. This includes exercise as well as any activity that is likely to increase your blood pressure. It is important to return to your daily activities gradually and as directed by your physician. It is imperative that you carefully follow all instructions provided to you by your surgeon in order to ensure a fast recovery and to minimize the risk for complications.
Initial results of your brow lift will be apparent immediately, but it will take several months before the final results are apparent. Bruising and most of the swelling will subside in the first week or two after the surgery, but it may take up to 6 months for all swelling to resolve. Brow lifts provide long-lasting results but, as with all cosmetic surgeries, they are not permanent. The development of wrinkles and sagging skin is an unfortunate consequence of the aging process, and while a brow lift is an effective way to minimize signs of aging, it will not prevent the development of subsequent signs of aging. Some clients elect to have additional brow lift surgeries within a decade of their initial surgery.
The average surgeon’s fee for a brow lift in the United States is approximately $3,000. This fee does not include several other costs, such as the anesthesia and the facility fee, which can bring the total brow lift cost to about $5,000. Before undergoing a brow lift or any other cosmetic procedure, it is important to understand the costs involved to be sure that there will be no hidden surprises. Some surgeons will only quote you their fee, not the total expense. Make sure you understand your quote and that it includes all potential fees before you schedule your surgery. Brow lift costs may include:
- Surgeon’s fee
- Anesthesia fees
- Hospital or surgical facility costs
- Medical tests
- Post-surgery garments
- Prescriptions for medication
What is the best age to have a brow lift? Any adult who is not satisfied with the appearance of his or her brow may be a great candidate for a brow lift. There is no “best” age for a brow lift, but most people are between 35 and 60 years old. Can asymmetric eyes or eyebrows be fixed? Asymmetries are often structural, meaning that they cannot be directly addressed with a brow lift. Asymmetrical eyes cannot be fixed with a brow lift, but a skilled plastic surgeon can minimize eye and eyebrow asymmetries. Browpexy versus browlift – what’s the difference? Browpexies are an effective way to address sagging eyebrows but will not reduce forehead wrinkles or sagging skin. Browpexies are frequently performed in conjunction with upper eyelid surgeries. Brow lifts can address sagging eyebrows as well as minimize wrinkles or sagging skin on the forehead. Is there any way to make my eyebrows more arched? For many people, strategically administered Botox can temporarily deliver the gracefully arched eyebrows that are so desirable. A sagging, heavy brow may be better addressed with a brow lift.
- American Society of Plastic Surgeons. Brow Lift Guide. Available from: https://www.plasticsurgery.org/cosmetic-procedures/brow-lift
- Bater KL, Ishii LE, Papel ID, et al. Association Between Facial Rejuvenation and Observer Ratings of Youth, Attractiveness, Success, and Health. JAMA Facial Plast Surg. 2017;19(5):360–367. Available from: https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/2622092
- Patel BC, Malhotra R. Mid Forehead Brow Lift. Treasure Island (FL): StatPearls Publishing; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535452/
- Raggio BS, Winters R. Endoscopic Brow Lift. Treasure Island (FL): StatPearls Publishing; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545220/
- Boughton, Barbara. The Nonsurgical Brow-Lift: Pleasing Patients and Diversifying Practices. EyeNet Magazine. September 2010. Available from: https://www.aao.org/eyenet/article/nonsurgical-brow-lift-pleasing-patients-diversifyi