How the Brow Lift Procedure Is Done

A brow lift procedure raises the eyebrows through an incision, and the main difference between approaches is where that incision goes. A direct brow lift places it right at the eyebrow, a mid forehead lift uses an existing forehead crease, and an endoscopic lift goes behind the hairline. The closer the incision is to the brow, the more lift it allows and the easier the scar is to see.

In this video, Dr. Thomas Buonassisi, MD, FRCSC, Specialist in Otolaryngology – Head and Neck Surgery, with a practice limited to facial plastic surgeries, explains the three approaches and how they compare. You can read about his approach to a brow lift in Vancouver on our treatment page.

Dr. Buonassisi explains the direct, mid forehead and endoscopic approaches to a brow lift.

What are the main approaches in a brow lift procedure?

There are three main approaches to a brow lift: direct, mid forehead and endoscopic. Dr. Buonassisi notes there are other versions of each, but these are the ones most brow lifts are based on. What separates them is where the incision sits, either very close to the eyebrow or far away from it, hidden in the hair.

That one choice shapes the two things most people care about: how much the brow can be lifted, and how visible the scar is. The comparison in the video sums it up:

• Direct: the most lift, with the most visible scar.
• Mid forehead: substantial lift, with a faint scar in a forehead crease.
• Endoscopic: a modest lift, with the scars hidden in the hair.

Each approach has its own advantages and disadvantages, covered below.

How is a direct brow lift done?

In a direct brow lift, a small incision is made right in the eyebrow tissue itself. Because the incision sits exactly where the lift is needed, this approach allows significant elevation of a brow that sits very low.

The trade-off is the scar. Dr. Buonassisi explains that incisions made right in the eyebrow are generally the most visible of the three approaches. In general, a direct brow lift comes up when a brow has dropped a lot, sometimes called brow ptosis, and the amount of lift matters more than where the scar sits.

What is a mid forehead brow lift?

A mid forehead brow lift uses a forehead wrinkle or skin crease that's already there to reach the eyebrow. The incision follows that crease, partway between the brow and the hairline.

According to Dr. Buonassisi, a mid forehead incision placed in a wrinkle often heals to a scar that's very hard to see, and it still allows a substantial lift of the eyebrow. Because it relies on an existing crease, it's an option for people who already have forehead lines where an incision can sit.

How does the endoscopic approach work?

The endoscopic approach is done through incisions within the hairline. In women, Dr. Buonassisi explains, those incisions are camouflaged by the hair, so they're hidden from view.

It does depend on having a hairline to hide them in. For men who are balding, he notes there's no particular advantage to placing an incision high up in the forehead. The other disadvantage is distance: the incisions are far away from the brow that needs lifting, so the elevation an endoscopic lift can achieve is often modest.

At 8 West, Dr. Buonassisi performs both endoscopic and direct brow lift techniques, depending on each person's anatomy and goals.

Where do brow lift incisions and scars end up?

No brow lift is scarless, because every approach needs an incision. The real question is where you'd rather have it. Brow lift incisions close to the eyebrow allow more lift and are easier to see, incisions in the hair are hidden and give less lift, and a forehead crease sits between the two.

Your own features change the picture. A high or receding hairline gives an endoscopic incision less to hide behind, while existing forehead lines can give a mid forehead incision a natural place to sit. That's why brow lift scars are part of the conversation at the consultation, along with how much lift your brows need.

You'll find more eyelid and brow articles and videos in the Eyes & Brows section of our Knowledge Centre.

How is the right brow lift approach chosen?

Dr. Buonassisi offers a range of brow lift approaches and chooses one based on each person's anatomy, brow position, skin quality and goals. The technique isn't decided ahead of time. It comes out of the consultation, where he looks at where your brows sit, how far they've descended, your skin and your hairline, and talks through which approach suits what you're hoping for.

It helps to write your questions down beforehand, for example:

• how much lift your brows need
• where the incision would go for you, and how visible it might be
• whether your hairline or forehead lines make one approach more suitable
• whether your upper eyelids are part of what you're noticing
• what recovery would involve

We see patients at 8 West Clinic in Vancouver and North Vancouver. If you'd like to read more before your consultation, our guide, The Essential Guide to Facial Rejuvenation, covers the brows and eyes along with the rest of the face.

Can a brow lift be done with eyelid surgery?

Yes. A brow lift is frequently combined with blepharoplasty, or eyelid surgery, for the upper face. A brow that has dropped can push skin down onto the upper eyelid, and eyelid surgery on its own doesn't raise the brow. When both are recommended, they can be done in the same surgery.

Our article on what to know before upper blepharoplasty explains how the eyelid and the brow are told apart.

Frequently asked questions

How long is recovery after a brow lift?

Recovery from a brow lift is typically one to two weeks. How it goes for you depends on the approach used and on how you heal. At the consultation, Dr. Buonassisi talks through what recovery would involve in your case, so you can work out the time you'd want to set aside for it.

Is there such a thing as a scarless brow lift?

No. Every brow lift approach uses an incision, so every one leaves a scar. What differs is how easy that scar is to see. Incisions in the hair can be hidden, a scar in a forehead crease is often hard to see, and a scar in the eyebrow is usually the most visible of the three.

Which brow lift approach suits men with a receding hairline?

Hairline is part of the decision. Dr. Buonassisi explains that for men who are balding, there's no particular advantage to placing the incision high up in the forehead, because there's no hair to hide it. At the consultation he looks at your hairline, forehead lines and brows, and explains which approach would suit you.

What is brow ptosis?

Brow ptosis is the medical term for an eyebrow that sits lower than it used to. In general, brows can descend with age, and for some people low brows run in the family. A brow that has dropped a lot is one of the situations where Dr. Buonassisi explains that a direct brow lift allows significant elevation.

Results vary. This content is for informational purposes only and does not constitute medical advice.