A brow lift is a plastic surgical procedure that is meant to improve both the position and shape of aging or sagging eyebrows. Various surgical approaches are available, depending on the gender of the patient, the amount of elevation required and the surgeon’s and patient’s preference.
Some misconceptions are that:
In fact, the inner corner of the brow and the central part of the brow do not generally descend with age. Sometimes they even get higher, or they appear to get higher because of hollowing below the brow in the upper lid area. The outer brow (lateral brow), on the other hand, does tend to sag with age resulting in an unattractive or tired brow shape. If the whole brow is lifted the same amount, then the unsightly aging brow is simply raised to a higher position, making it even more obvious. The ideal brow lift almost always lifts the lateral brow MORE than the central and inner brow to improve the SHAPE of the brow. If you look in magazines at young attractive people, they almost always have lateral brows that are at the same level or even higher than the inner corner. So the key to brow lifting is to lift the tail of the brow MORE than the inner/central portions to improve brow contour. The SHAPE of the brow is more important than the HEIGHT of the brow, as a general rule.
The following article discusses the difference between two common procedures: the lateral brow lift and the endoscopic brow lift.
Lateral Brow Lift
A lateral brow lift, also called a temporal brow lift, targets only the outer one-third of the eyebrow instead of the entire brow. Using this surgical approach, the plastic surgeon is able to change the shape of the brow to one that is more youthful and attractive. If you stand in front of a mirror and raise the outer portion of the brow with your finger and you find the change attractive, you may be a candidate.
The procedure can be combined with a blepharoplasty or performed as a stand-alone procedure.
A lateral brow lift is either performed through an incision within the hair or at the temporal hairline. You might instinctively say that you prefer the incision hidden in the hair but that incision may cause a small bald spot and will lift the hairline making the forehead higher. In patients with thin hair or who have a high forehead, incision at the hairline is preferred. In addition to different incisions, the brow lift can be performed in different surgical planes (subcutaneous, subgaleal, subperiosteal), and that decision is made based on surgeon preference. The largest amount of lift is accomplished with the most superficial dissection (subcutaneous) and the least amount of lift is accomplished with the deepest dissection (subperiosteal).
Endoscopic Brow Lift
An endoscopic brow lift simply means that an endoscope is used to facilitate the procedure. So, in reality, comparing the lateral brow lift and endoscopic brow lift is not a great comparison, since one describes the part of the brow being lifted and the other describes the technique for doing it. For example, a lateral brow lift could theoretically be performed using the endoscope, resulting in an “endoscopic lateral brow lift”, but for reasons outlined below that is usually not done.
The benefit of the endoscopic procedure, just as in laparoscopic removal of the gall bladder, is that smaller incisions are made that are further from the brow, helping with the disguise. The downside of the endoscopic procedure is related to the biggest advantage; that is, because the lift is far away from the brow requires lifting, it is less powerful and less effective, and less long-lasting.
During the procedure, the plastic surgeon will place several small incisions behind the hairline.
An endoscope is then inserted through the incisions to perform various maneuvers. Another disadvantage to the endoscopic brow lift, besides concerns about effectiveness, is that it is better for elevating the inner corner of the brow rather than the outer corner, and as mentioned above, that is usually not what most patients need.
So, what’s the deal?
A lateral brow lift involves larger incisions than the endoscopic brow lift but is generally more effective in lifting the part of the eyebrow that usually needs lifting. The endoscopic brow lift is still commonly performed but it is this author’s sense that it is used less frequently than it once was as we learn more about ideal brow aesthetics. There are other brow lift techniques that were not mentioned in this article, such as the coronal lift, which is less commonly performed and reserved for specific circumstances.
Choosing a Brow Lift Specialist
If you're looking for a brow lift surgery, make sure to consult a plastic surgeon with aesthetic surgery experience to determine your candidacy.
Dr. Charles Thorne is a Park Avenue plastic surgeon with over thirty years of experience. He can tell you whether you're a good candidate for a brow lift and which technique would be best in your circumstance.
Schedule a virtual appointment with Dr. Thorne today.
Dr. Thorne is the Editor-in-Chief and the author of several chapters in Grabb and Smith's PLASTIC SURGERY, 7th Edition.
