Brow ptosis — the descent of the brow below its ideal position — contributes to a tired, heavy, or stern appearance that no amount of eyelid surgery can fully correct. The brow lift (or browplasty) corrects this descent. Multiple techniques exist, each with specific indications, advantages, and trade-offs. The right choice depends on the degree of descent, hairline position, and what other procedures are being performed.
Endoscopic Brow Lift
The endoscopic technique uses small incisions hidden behind the hairline, through which a camera and instruments are used to release the brow’s retaining ligaments and reposition the forehead tissues superiorly. It leaves minimal scarring, preserves forehead sensation better than open techniques, and has become the most common approach in suitable candidates. It works best in patients without significant skin excess and with a normal or low hairline.
Coronal Brow Lift
The coronal approach involves a long incision across the top of the scalp, allowing direct excision of excess scalp skin and direct repositioning of the forehead tissues. It produces reliable, durable elevation and is appropriate for patients with deep forehead rhytids, significant brow ptosis, and a low hairline. The trade-off is a longer scar and the potential for hairline elevation — a concern in patients with high foreheads.
Direct Brow Lift
A direct brow lift involves excision of skin directly above the brow, producing immediate and powerful elevation. The visible scar at the brow margin limits its use to specific populations: older male patients with heavy brows and prominent forehead rhytids in whom the scar blends well, and patients with facial nerve palsy requiring one-sided correction. It is not the first choice for most cosmetic patients due to scar visibility.
The Brow–Eyelid Relationship
Brow position profoundly affects apparent eyelid fullness. Many patients who present requesting upper blepharoplasty have brow ptosis as the primary driver of their tired appearance. Operating on the eyelid without addressing the brow can produce an inadequate result or worsen the appearance by removing skin needed to cover a future brow lift. Dr. Truesdale evaluates the brow-eyelid complex together at every upper eyelid consultation.