The Different Types of Brow Lifts: Surgical Approaches, Pros, Cons, and Longevity
Have you ever wondered about the different types of eyebrow lifts? In my practice, I perform several different types of brow lifts, including coronal brow lifts, pre-trichial brow lifts, endoscopic brow lifts, lateral brow lifts, and direct brow lifts. Each brow lift type has different pros and cons. When determining the optimal brow lift for a patient, my decision-making process is influenced primarily by my patient’s anatomy and cosmetic goals. Here’s a quick rundown of the different types of brow lifts that I perform (and one type that I no longer perform). Enjoy!
Coronal Brow lift
In a coronal brow lift. the incision is made 2-4 inches behind the hairline, and it extends from temple to temple and goes across the top of your scalp. A strip of skin (scalp) and deep tissue is removed to help elevate the brows.
Pros: A coronal brow lift is a powerful procedure that creates a great lift, and the incision is hidden behind hairline once healed. This is a good procedure for patients with severe brow ptosis.
Cons/Risks: There is a small but real risk of damage to temporal branch of facial nerve, which can lead to frontalis muscle weakness (i.e. the muscle that you use to lift your brows/wrinkle forehead… can be asymmetric). Your scalp will be numb at least temporarily in the area behind the incision. A coronal brow lift is not a good procedure for patients with high foreheads, as a coronal brow lift can pull the hairline backward and make one’s forehead appear higher. There is a small risk for hair loss along the incision.
Pre-Trichial (Trichophytic) Brow Lift
A pre-trichial brow lift is like a coronal brow lift, but the incision is made just in front of the patient’s upper hairline. The incision extends from forehead to temple on both sides. The lateral aspects of the incision are behind the hairline but not as far posterior (back) as the incision in a coronal brow lift.
Pros: A pre-trichial brow lift is a powerful procedure that provide a great lift. The aspect of the incision that is along the hairline usually heals as a very narrow white scar, and hair often grows through the scar. A pre-trichial brow lift can be used to lower the hairline in patients with high hairlines/elongated foreheads.
Cons: There is a small but real risk of damage to temporal branch of facial nerve, which can lead to frontalis muscle weakness (i.e. the muscle that you use to lift your brows/wrinkle forehead… can be asymmetric). Your scalp will be numb at least temporarily in the area behind the incision. A coronal brow lift is not a good procedure for patients with low/short foreheads, as a pre-trichial brow lift will shorten the height of the forehead. There is a small risk for hair loss along the incision.
Endoscopic brow lift
In an endopscopic brow lift, four or five small incisions made about an inch behind the hairline. Dissection is then carried out with an endoscope to visualize and avoid damaging important structures in the forehead (i.e. nerves and blood vessels). Adhesive tissue along the upper rim of the orbit is then released, which allows the brows to be elevated. Bone tunnels or endotines (dissolving pegs) can be used to to help anchor the brows into their elevated position. An endoscopic brow lift helps to lift the entire brow, from its inner portion, all the way out to the outer portion.
Pros: The incisions in an endoscopic brow lift are small and behind the hairline. The incisions are difficult to see once healed. An endoscopic brow lift provides lift for the entire width of the brow.
Cons: As the incisions are behind the hairline, there is a small risk of hair loss at the incision sites (less risk than coronal and pre-trichial lifts). There is also a small risk of damage to the temporal branch of the facial nerve (low risk, approximately same as coronal and pre-trichial lifts). In my experience, this is not a good procedure for patients with severe eyebrow ptosis or very thick forehead skin/tissue.
Lateral brow lift
In a lateral brow lift, the incision is made in the area of the temple, and it can be made behind or in front of hairline. This procedure focuses on lifting the lateral (outer) part of the eyebrow, and thus I’d say it’s more appropriate for addressing smaller amounts of eyebrow ptosis (not everyone needs a coronal, pre-trichial, or endoscopic brow lift). I primarily perform this procedure to improve the appearance of lateral hooding (i.e. the droopy upper eyelid and brow skin at the outer aspect of the eyelid that cannot be removed as part of an upper lid blepharoplasty, as doing so would create a more visible, unnatural scar).
Pros: The incision is usually hidden behind the hairline (depends on position of each patient’s hairline). The scar usually heals as a narrow white line, often with hair growing through it. A lateral brow lift takes less time in the OR than endoscopic brow, coronal brow, and pre-trichial brow lifts.
Cons: There is a small risk of temporary or permanent hair loss in area of incision. The is a small risk of damage to the temporal branch of the facial nerve, which can lead to frontalis muscle weakness (i.e. the muscle that you use to lift your brows/wrinkle forehead, and this weakness can be asymmetric). For patients with severe brow ptosis, this is not the procedure of choice. The results are more subtle.
Direct brow lift
In a direct brow lift, the incision is made directly above the brow. This surgery is usually done for functional purposes (i.e., to improve peripheral vision).
Pros: Powerful procedure that yields a great lift.
Cons: Direct brow lifts are often associated with a visible scar above the brow, even once healed. For some patients, this procedure can create an overly arched appearance of the brow.
Internal Browpexy
In my hands, I’ve generally been disappointed with the longevity of internal browpexy. In my experience, these patients look great for 3-6 months after surgery, and then their brows inevitably drop. Thus, I no longer perform this procedure.
With regard to longevity as a whole, it can be difficult to predict. We often over-correct brow position during surgery with the understanding that the brows will fall down gradually over time. Over the initial months following surgery, your brows likely will fall somewhat from where they were immediately after surgery, but ideally, they will fall to a natural position that is improved from the pre-operative position.
In a perfect world, your brows will stay up for ~10 years with an endobrow or lateral brow lift. Coronal and pre-trichial (trichophytic) lifts likely have a bit more longevity than an endobrow or lateral brow lift. I recently heard the quote “You don’t buy plastic surgery, you rent it,” and I think this is important to remember. I often tell my patients that I can’t turn off time and gravity.
Nothing is permanent.
Another concept to remember is maintenance. For example, when we buy a car, we understand that we have to change the oil and take the car in for service on a regular basis. Facial plastic surgery is similar, primarily because our faces move so much (talking, emoting, etc), and our facial volume changes over time. As it pertains to brow lifts, regular maintenance with Botox to the crow’s feet area and glabella can significantly increase the longevity of one’s surgery (these are the muscles that pull the brows down, and if they are weakened, the brows stay up longer).
There are many reasons a brow lift can fail. Sometimes, tissue is not released adequately during surgery. For other patients, they stop subconsciously contracting their frontalis muscle (i.e. the muscle that lifts the brows) once the brows have been surgically lifted, and thus the brows drop further than anticipated post-operatively (although we overcorrect with the understanding that the brows will fall a bit, it’s not always predictable… if we overcorrect too much, you will look “surprised”). Other times, it may be due to procedure selection. For example, not everyone is a good candidate for an endoscopic browlift. For some, a coronal or pre-trichial (trichophytic) brow lift will create a better lift, but as I noted in the initial post, there are more tradeoffs (numbness, scars) with pre-trichial and coronal lifts than with an endoscopic brow lift. These are all factors to weigh when deciding on which procedure will best suit your aesthetic goals.
Hope this blog post was helpful! If you would like to see before-and-after photos of patients who have undergone brow lift surgery, please click the “before & after” link at the top of the page.
If you have more questions about brow lifts or would like to schedule a consultation to discuss brow lifts and other surgical options, please contact us.
