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Ross A. Clevens, MD, FACS

The terms brow lift and forehead lift are generally used interchangeably. A brow lift or forehead lift refers to a surgical procedure that rejuvenates the upper one-third of the face. The upper one-third of the face encompasses the brows, horizontal forehead lines, vertical lines between the brows (the “11’s”), and oftentimes the position of the hairline itself.

Brow lift and forehead lift techniques aim to create a more youthful and rested appearance to the upper one-third of the face, to smooth the forehead and brow lines and to elevate or reposition the brows which also opens the eyes. Forehead lift and brow lift are often performed with eyelid surgery (blepharoplasty) and facelift surgery, although they can also be performed alone. 

Types Of Brow Lifts

There are a number of different types or surgical approaches to rejuvenate the brow and forehead. These are generally named based upon where the incisions for the procedure are placed. This would include the direct brow lift, mid brow lift, trichophytic forehead lift, bicoronal forehead lift, and the endoscopic brow lift. The temple lift is also a specialized type of brow lift.

The Direct Brow Lift

The direct brow lift is the brow lift procedure where the incision is placed just above the eyebrow. The incision is placed at the juncture of the hair-bearing brow skin and immediately adjacent non-hair-bearing brow skin. In properly selected patients, the direct brow lift incision fades nicely over time and is very well hidden and often imperceptible. 

The main advantage of the direct brow lift is the precision with which the brows themselves can be repositioned, elevated or shaped. Patients also benefit from the simplicity, quick recovery and short downtime associated with this procedure. This approach is best suited to patients who want their brow shape or position changed, but are not bothered by other aging changes in the upper one-third of the face as the direct brow lift does not improve horizontal or vertical lines in the forehead nor, of course, does it reposition the frontal hairline. 

The Mid-Brow Lift

The mid-brow lift is a common approach in brow lift surgery, particularly in men or in aging patients with prominent horizontal forehead lines. The mid brow lift approach involves placing incisions in the mid forehead within pre-existing horizontal forehead lines and wrinkles. Upon healing, the incisions are nicely camouflaged with the horizontal forehead lines. Advantages of the mid-brow lift include the simplicity and immediacy of the approach and its success in favorably repositioning, shaping, and/or elevating the brows. The mid-brow lift generally does not improve horizontal forehead lines, although it may improve vertical lines between the brows. This is the most common approach in men. 

The Trichophytic Forehead Lift or Brow Lift (Hairline-Lowering Brow Lift)

The trichophytic forehead lift or brow lift approach involves carefully placing an incision along the frontal hairline. This incision is created such that it is well camouflaged within the frontal hairline and hair will actually grow up through the incision with time. The fact that hair will grow up through the incision itself further helps to hide the hairline. This approach may successfully be used in patients with short hair, male patients or even female patients who wear their hair back. 

The trichophytic brow lift and forehead lift successfully smooths horizontal forehead lines, vertical brow furrows (the “11’s”) and shapes, repositions, and rejuvenates heavy or droopy brows. A chief advantage of the trichophytic forehead is that this brow lift approach allows us to reposition the hairline. An elevated hairline is an aging and masculinizing characteristic in women. Many women are troubled by a receding hairline or a long and high forehead which is an aging and masculinizing characteristic. The receding hairline is successfully addressed by a trichophytic forehead lift where the hairline can be lowered to a more feminine and youthful position. 

In the trichophytic brow lift and forehead lift, in addition to rejuvenating the forehead and brow regions, the anterior frontal hairline can be lowered by up to one inch in many patients. Some will call this approach the “hairline lowering forehead lift” and so it is very desirable particularly in many women in conjunction with other facial rejuvenative procedures such as eyelid surgery and facelift surgery.

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The Bicoronal Forehead Lift or Brow Lift

This approach is discussed mainly out of completeness and historical interest as it is not frequently performed today. This traditional forehead lift approach involves creating an incision that spans from ear-to-ear across the top of the head. Although reliable and long lasting, this procedure is plagued with unwanted elevation of the frontal hairline and often unfavorable and visible scarring. So, in the present time, this procedure is not commonly performed except in special or extenuating circumstances. 

The Endoscopic Forehead or Brow Lift

The endoscopic forehead lift is an approach which uses two to three small incisions placed behind the frontal hairline. These incisions are typically 1 to 2 cm in length and generally are two to three in number depending upon the approach of the surgeon. The main advantages of the endoscopic brow lift is that it does not alter the hairline and that it uses small keyhole incisions hidden within the hair that fade away with time. 

This approach is best suited for patients who are pleased with the level of their frontal hairline, mainly desire elevation or repositioning of their brows and are less bothered by horizontal and vertical lines in the forehead as the endoscopic brow lift does not address wrinkling in the forehead as well as some other brow lift approaches such as the trichophytic forehead lift. The endoscopic approach, though appealing, tends not to last as long as other brow lift techniques. 

The Temple Lift or Brow Lift

The temple lift is an approach that elevates the lateral (sides) of the brow. This procedure is particularly helpful for patients who experience droopiness of the lateral brow and want more of an elevation of the temple or side aspect of their brows. Depending upon the preference of the surgeon, this procedure may be performed with an incision hidden either along the upper aspect of the eyebrow itself or perhaps in the hairline. This is a successful and long-lasting approach to elevate and reposition the lateral aspect of the brow to help open the eyes. 

Decision-Making In Brow Lift Surgery

The decision-making in brow lift surgery is mainly dictated by the preferences of the patient and the skill of the surgeon. There is no one approach to the brow that is ideal in all patients. It is important that the surgeon understand and be comfortable with all techniques for brow rejuvenation in order to deliver the ideal results to each individual patient: 

Mid Brow Lift

If a patient has deep horizontal forehead lines and creases and desires mainly elevation of the brow, then a mid brow lift approach may be elected.

Direct Brow Approach

If a patient’s main concern is repositioning of the brow and elevation of the brow to alleviate droopiness in this region and horizontal and forehead lines are not a particular concern to the patient, then a direct brow approach may be taken. 

Temple Lift

The temple lift is particularly useful in patients who are concerned with elevation of the lateral (sides) of the brow. 

Trichophytic Forehead Lift

The trichophytic forehead lift is particularly useful in rejuvenation of the forehead and brow in women who have experienced an elevation of the hairline. This elevation of the hairline is an undesirable aging and masculinizing characteristic of the forehead. The trichophytic approach allows the hairline to be lowered to restore a more youthful and more feminine position, while smoothing the forehead and brow while repositioning the eyebrows themselves. 

Endoscopic Forehead Lift

The endoscopic forehead lift is not successful in patients with heavy brows nor in patients with horizontal and vertical lines affecting the forehead and brow, though the endoscopic brow lift is useful particularly in younger, more youthful women who are pleased with the position of their hairline.

The best way to determine which type of brow lift or forehead lift is right for you is to meet in consultation with a facial plastic surgery specialist. In your consultation, you can discuss your goals, get all your questions answered, and find out if you are a candidate for the brow lift that interests you.

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