Brow lift and browpexy

What it is

A group of operations that raise the eyebrow or stop it descending. The endoscopic brow lift works through four or five short incisions behind the hairline, with a camera passed under the scalp; the temporal or lateral brow lift is a smaller version that raises only the outer third; a direct brow lift removes a strip of skin immediately above the brow and is usually reserved for older patients or for facial nerve weakness, because the scar is on the face rather than hidden.

Browpexy is the smallest member of the family. Rather than lifting the brow it anchors it, through the same incision used for upper eyelid surgery, and its realistic effect is a millimetre or two plus resistance to further drop.

How it works

The brow sits where the muscles that lift it and the muscles that pull it down reach a truce. Frontalis lifts. Corrugator, procerus and the orbital part of orbicularis oculi pull down. Every version of this operation either releases the depressors, fixes the lifted tissue to the skull so it cannot slide back, or both.

What matters for the measurement LooksRatio takes is that the change is real but small. Published series put the average brow elevation from an endoscopic lift at a few millimetres, larger at the tail of the brow than at the head, and a lift that raises the whole brow evenly by a centimetre is not a surgical result, it is a photograph taken with the eyebrows raised.

Why it is on this list at all

Because the alternative is worse. A heavy upper lid is often a low brow rather than excess eyelid skin, and removing eyelid skin from someone whose real problem is brow position pulls the brow further down and locks the appearance in. Surgeons assess the brow before they assess the lid for exactly this reason, and a report that named eyelid surgery and stayed silent about the brow would be repeating the mistake.

Recovery

Swelling and bruising around the eyes and forehead for one to two weeks. Numbness and itching behind the hairline are normal for weeks to months as the sensory nerves recover. Most people are presentable at two weeks.

The result settles over three to six months, and it settles downwards: some of the early lift is swelling, so a brow that looks surprised at two weeks usually is not the result.

Risks and what actually goes wrong

The specific ones are numbness of the scalp, hair loss along the incisions, brow asymmetry, a permanently surprised look from over-elevation, and injury to the temporal branch of the facial nerve, which supplies frontalis. The last is uncommon and usually temporary, but when it is not, the forehead on that side no longer moves.

The more ordinary failure is relapse. The forehead is under constant load from the muscles pulling it down, and fixation methods vary in how well they hold, which is why the published elevation figures shrink as the follow-up lengthens.

Lower-commitment alternatives

Botulinum toxin placed in the depressors gives a chemical brow lift. Treating the lateral orbicularis, and treating the glabellar complex, removes the downward pull and lets frontalis win by roughly one to two millimetres at the tail of the brow. It is reversible by doing nothing for three to four months, which makes it the sensible thing to try first, and it is also how a surgeon and a patient find out whether a higher brow is what they actually wanted.

Injecting the wrong muscle, or too much of the right one, drops the brow instead of raising it. That is temporary too.

What LooksRatio assumes

The projection moves brow position 75% of the way to its reference range and assumes a successful result from a licensed surgeon. It models nothing about your forehead height, your hairline, your skin, the surgeon, or how much of the lift holds at five years. It is a ceiling, not a forecast.