Brow Lift Surgery Options

Eyebrows are located at the lower part of the forehead and serve as a tuft of hair arranged to prevent sweat from entering the eyes. In aesthetic surgery, we consider not only the superficial hair but also the underlying soft tissue mass as part of the eyebrow. In plastic surgery, eyebrow aesthetics is not just a term related to the model of the eyebrow. The aesthetics of the eyebrow is closely related to the aesthetics of the upper eyelid.

Table of Contents:

• Aesthetic Relationship of Eyebrows with Surrounding Structures
• Why Do Eyebrows Droop? How Does the Aging Process Affect Them?
• How Is Eyebrow Droop Treated? How Are Eyebrows Lifted?
• Forehead Lift and Brow Lift Techniques
• Isolated Brow Lift Techniques
• Direct Brow Lift
• Brow Lift Through Eyelid Surgery (Transblepharoplasty Browpexy)
• Brow Suspension (Thread Lift Brow Suspension)
• Botox
• Cosmetic Applications

Aesthetic Relationship of Eyebrows with Surrounding Structures

Eyebrows are a part of the forehead. When the forehead droops, the eyebrows sag. The aging of the forehead is closely related to the aging and function of the muscles. The muscles in the forehead can both lift and lower the eyebrows. Eyebrows also have a functional and aesthetic unity with the upper eyelid. When the eyebrows droop, the soft tissue mass, which normally sits below the eyebrow, overlaps the eyelid. This sagging of soft tissue can create an illusion as if there is excess skin on the eyelid.

Why Do Eyebrows Droop? How Does the Aging Process Affect Them?

The structure of the eyebrows varies from patient to patient. In men, the eyebrow position is lower compared to women, and in male aesthetics, low eyebrows are desirable. Many young, attractive individuals naturally have low eyebrows. If a person is dissatisfied with a congenital low eyebrow position, they may be a suitable candidate for brow lift surgery even at a young age.

The most natural and common cause of eyebrow droop is aging. As the forehead tissue ages, the amount of subcutaneous fat tissue significantly decreases. Just as the surface of a pillow becomes loose and saggy when its filling is removed, the eyebrows sag due to the loss of volume in the forehead area and the effect of gravity.

Another cause of eyebrow droop is repeated Botox applications. If the muscles that lift the eyebrows are weakened during repeated Botox sessions, eyebrow droop may occur.

How Is Eyebrow Droop Treated? How Are Eyebrows Lifted?

The methods used to lift the eyebrows can be divided into three groups, including surgical procedures and non-surgical applications. The first group includes surgical techniques that lift the eyebrows by tightening the forehead and temple area. The second group includes isolated brow lift techniques that lift the eyebrows without tightening the forehead and temple area. The third group includes neurotoxin applications that modify the muscles that lower and lift the eyebrows, changing the dynamic position of the eyebrows.

Forehead Lift and Brow Lift Techniques

The methods I prefer most for lifting eyebrows are in this group. Forehead lift surgeries not only lift the eyebrows but also tighten the forehead skin, reduce wrinkles, and create a more holistic aesthetic result. In forehead lift surgeries, the entire eyebrow is lifted, not just a single point, allowing the eyebrow to be elevated in a way that preserves its ideal aesthetic form. These surgeries are the most effective treatment for eyebrow droop caused by the effects of gravity.

Among forehead lift surgeries, one of the most modern methods is the endoscopic forehead lift. In this surgery, small incisions are made in the scalp, and the forehead and eyebrow tissues are separated from the skeletal structure with the help of an endoscopic camera. The forehead and eyebrows are then pulled back over the skull and fixed with permanent sutures in micro bone tunnels created in the skull. It wouldn’t be an exaggeration to say that I recommend endoscopic forehead lift surgery to two out of every three patients who come to my clinic with a desire for a brow lift.

Forehead lift surgery can also be performed with longer incisions within or in front of the hairline. You can find different articles about these surgical techniques on the blog.

The area on the side of the forehead is called the temple. In some surgical approaches, only the temple area is lifted, not the entire forehead. Lifting the temple area can slightly raise the outermost parts of the eyebrows. Temple lift surgeries can be an option for patients whose outer eyebrows are significantly drooping and who are willing to accept a slight flattening of the eyebrows in the aesthetic result.

Isolated Brow Lift Techniques

While treating the forehead/temple/brow unit holistically is our first choice and the most ideal treatment option, including the forehead and temple area in the treatment is not mandatory for lifting the eyebrows.

Eyebrows can be lifted independently, or in isolation, from the forehead and temples. For instance, with a simple Botox application, the muscles that pull the eyebrows downward can be weakened, resulting in a temporary 1-2 mm lift of the eyebrows.

Among the isolated brow lift techniques, the two techniques I prefer the most are brow lift through eyelid surgery (transblepharoplasty) and direct brow lift techniques.

Direct Brow Lift

In the direct brow lift technique, incisions are made along the line where the eyebrows meet the skin. A skin ellipse is removed from above the eyebrow, and the elliptical skin opening is re-stitched to form a straight line. This technique directly lifts the eyebrow and corrects eyebrow droop. However, it leaves a visible scar between the eyebrow and forehead skin. The direct brow lift technique is quite effective. Its advantages include simplicity, quick recovery, local anesthesia, and few complications. The ideal patients for this surgical technique are men with advanced aging of the forehead. Within about 6 months to a year, the surgical scar will appear as one of the wrinkles on the forehead and won’t be noticeable. However, this technique is not suitable for the middle-aged group, where the forehead wrinkles are not deep enough to camouflage the scar.

Brow Lift Through Eyelid Surgery (Transblepharoplasty Browpexy)

In the transblepharoplasty brow lift technique, the upper eyelid surgery incision is extended upward to release the tissue beneath the eyebrow. The eyebrow is then anchored to the connective tissues overlying the forehead bone with permanent sutures. This technique can raise the eyebrow by 1-3 mm and, more importantly, prevent eyebrow droop after upper eyelid surgery. It is also possible to combine this technique with the placement of an implant under the eyebrow to restore its fullness.

Brow Suspension (Thread Lift Brow Suspension)

In these techniques, various threads or suspension materials are used to suspend the eyebrow. I do not prefer isolated brow lift suspension methods. The reason is the artificial appearance that can result from these procedures. Try lifting your eyebrow voluntarily in front of a mirror and observe your face. Then lift your eyebrow with your finger and observe again. When you lift only your eyebrow, a skin fold forms immediately above the eyebrow on the forehead. This fold is natural, unnoticed, and not perceived as unnatural when it occurs only for 1-2 seconds during the brow lift expression.

In isolated brow lift suspension techniques, the formation of such skin folds and abnormal mimicry are common issues. Sometimes, everything may seem normal on a face without expressions, but unnatural tension lines can appear during facial expressions, which can be very disturbing in social life. These techniques can also distort the natural shape of the eyebrow, especially when thicker materials like French threads are used, causing tension lines under the skin to be visible from the outside.

Botox

Botox can raise the eyebrows by a few millimeters. However, not every Botox application lifts the eyebrows; some may even lower them. During Botox application, if the muscles that pull the eyebrows downward are weakened while the muscles that lift the eyebrows are not included in the treatment, the eyebrows may appear slightly higher. There are some limitations to Botox application. In cases where the eyebrows are anatomically very low, the effect of Botox may not be sufficient to create a noticeable and permanent change.

Cosmetic Applications

Some makeup applications can create an illusion of higher eyebrows by illuminating the convex surface just below the eyebrow. Eyebrow designs performed in beauty centers can make the eyebrow appear higher than it is. If you leave the hair at the top of the eyebrows and remove the hair at the bottom, the eyebrows may appear slightly higher. In patients with eyebrow hair loss, eyebrow tattoo applications can be performed. Plastic surgeons especially recommend that eyebrow tattoos not be done above the original brow line. This is because if a brow lift surgery is performed later, the tattoo, which has been moved upwards, may be positioned in a very exaggerated and unnatural way after surgery.