Opinion on Lateral Brow Lift

Hi Dr. Yang,

What is your opinion regarding lateral brow lift, with incision on the scalp?

That question is really difficult for me to answer, because my philosophy of facial aging and facial rejuvenation surgery has led me away from this procedure. I will give my opinion by discussing my observations of facial aging, and let’s see if any of it makes sense to you.

Lateral browlifts have their place as a surgical procedure to lift the tail of the brow, but it is my observation and opinion that youthful brows tend to be relatively flatter, and in some cases lower, when comparing photos of my patients currently (typically in their 50′s-60′s) to photos of themselves when they were younger in their (20′s-30′s). I think that it is a procedure that both patients and surgeons consider more for the lateral hooding of the upper eyelid, than for the positioning of the lateral brow.

Take a look at one of my patients here:

If you look at her left eyebrow (the side with the elevated lateral tail of the brow) on her pre-op photos, the initial diagnosis may be to perform a lateral browlift on the right side to match the left side, and make both eyebrows elevated at the lateral tail and have arched brows. This would also relieve the lateral hooding of the right upper eyelid. However, if you look at her photos at age 23, her eyebrows were symmetric and was not elevated and arched like her left eyebrow. According to the current philosophy of plastic surgeons, the eyebrows “fall” as we age, therefore the proper procedure is to lift the brow to counteract the change. However, if I look at my patients younger photos and current photos objectively, I have noticed that in many cases, the patient’s brow may actually be higher than they were in youth. I also see patients who have deeper set eyes who do not lift their eyebrows and their eyebrows really do look lower. However, when compared with their younger photos, the eyebrow heighth hasn’t changed. How is this possible?

I strongly believe that as we age we are losing fat between the eyebrows and eyelid crease. If deflation of this area of skin between the eyebrow and the eyelid crease can result in “excess skin” which can manifest as lateral hooding of the upper eyelids. The patient can react to this excess skin in two ways, which are shown in the patient above. Either the patient will raise their eyebrow, which gets the excess skin off of their upper eyelid and actually show more eyelid than they may have had in youth, or the patient may keep their eyebrows stationary, and their upper eyelid appears heavy, with lateral hooding.

Take a look at her before and after photos:



On her after photos, you can see that her left eyebrow has relaxed to a “neutral position” as compared to the initially elevated left eyebrow arch of the pre-operative photo. The upper eyelid surgery with fat grafting has increased the amount of skin showing below the eyebrow, although it has reduced the amount of eyelid showing on the her left side, while increasing the amount of eyelid showing on the right side. No browlift, or lateral browlift was performed. An equal amount of skin was removed from both eyelids, the only difference was that her left upper eyelid required more fat replacement than the right side.

I think it makes more sense that a person’s face can lose fat at different rates on the left and right side as they age, as opposed to, a person gradually “dropping” their brow on one side over the years, or a person somehow “grows” extra upper eyelid skin which then needs to be removed. An upper eyelid surgery “cuts out” extra upper eyelid skin, while a browlift, scrapes the scalp off of the forehead bone and positions it higher on the forehead bone as it heals. I just don’t see how the forehead and brow, slipped down the forehead bone over the years. It seems to be quite a secure attachment, to the point that if the forehead and brow, is not completely released off of the forehead bone, the browlift will not be long lasting, and may return to its original position.

Dr. Yang