Brow Lift

Many people already know that brow lift surgery can elevate the sagging brow, leading to a more youthful appearance. However, not everyone knows that it can inadvertently alleviate migraine, improve perceived personality traits, and reduce the hooded appearance of the upper lid.


Leading Orange County plastic surgery expert Dr. Tarick Smiley has explained the lesser-known brow lift benefits.


brow lift benefits

before and after photos depicting great results from brow lift surgery


  • Alleviate or even eliminate migraines


Surgeons say that some patients who have had brow lift, also referred to as forehead lift, reported less frequent migraine attacks or even complete remission. Experts have concluded that elevating the sagging tissue may release the pressure that is “pinching” or “irritating” the nerves responsible for chronic headache and its secondary symptoms such as light and nose sensitivity, blurry vision, and nausea.


  • Increase trustworthiness


Researchers at the New York University have conducted a survey showing that people with high eyebrow, which is medically referred to as high oblique frame or wide brow-lid complex, were perceived to be more honest and trustworthy by others.


Whereas people with furrowed brow, either caused by aging or as an inherited feature, scored lower in the perceived trustworthiness reviews.


Aging causes the brow particularly the lateral or tail end to sag, which can lead to an angry or sad appearance, depending on the degree or angle of droop.


Most patients will only need their brow’s tail end elevated, with no or very little advancement of the inner or medial aspect, to achieve a more refreshed appearance.


  • Increase femininity


A youthful female brow lies slightly above the bony orbital rim of the eye socket, and also comes with a soft lateral arch.   But with aging, the soft tissue sags causing the tail end to lose its height, leading to a more horizontally oriented shape of the brow.


Therefore, most brow lifts just require conservative elevation of the tail end to restore the lost arch.


  • Reduction of wrinkled skin in the upper eyelid


Occasionally, the drooping brow causes skin wrinkles and “heaviness” along the brow-upper lid complex. Hence, lifting the tail end of the brow could make the eyes appear more alert and more youthful without resorting to a separate procedure in the form of upper eyelid (blepharoplasty).

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The effects of facial plastic surgery on perceived youthfulness and attractiveness have already been demonstrated by several studies, which typically included ordinary observers who were asked to rate before-and-after photos. However, youth and beauty are not the only defining elements of the face; assertiveness, agreeableness, trustworthiness, and femininity/masculinity also play a role.


A 2015 study conducted by researchers at Georgetown University has shed light on the issue of perceived personality traits and how these could be altered by facial plastic surgeries such as face lift, brow lift, neck lift and eyelid lift. Rhinoplasty, or nose job in layman’s term, was not included because it has no or very little effect on a person’s neutral expression, they suggested.


facial plastic surgery

To eliminate confounding variables like ethnicity and gender, the researchers presented before-and-after photos of 30 white female patients who have had some type of facial plastic surgery. About 170 respondents answered the survey posted online.


The pre- and post-operative photos of the same patient were not presented in a photographic set to prevent recall bias or direct comparison, the researchers noted in the study.


Patients who have had facelift and lower eyelid surgery scored the highest in the personality trait assessments that included perceived attractiveness, social skills, femininity, and likability.


Interestingly, a separate study has suggested that people with high eyebrows and prominent cheekbones were perceived to be more honest even though there was no evidence that facial features were linked to personality traits.


Individuals with flat or sunken cheeks and furrowed brows, on the other hand, were perceived to be less trustworthy.


Meanwhile, a team of psychologists at the New York University has suggested that it takes 33 milliseconds, or a fraction of a time it takes to blink, for the brain to decide a person’s trustworthiness based on his/her face.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who was not part of the study, says the findings did not surprise him, as increasing the oblique frame—the distance between the brow and upper lid crease—during brow lift surgery not just leads to a more youthful countenance, but also results in improved trustworthiness and femininity.


Dr. Smiley says that a sagging brow may lead to a perennially angry or sad appearance, depending on the degree or angle of droop, and so a conservative elevation during brow lift can improve a person’s neutral expression—or even her non-physical personality attributes.


Facelift can also improve the perceived likability and trustworthiness by correcting the sunken cheeks, which is done by elevating the drooping cheek fat pad into the deeper tissue.


However, Dr. Smiley warns that the success of facial surgery relies largely on the surgeon’s qualifications and experience, adding that pulling the skin more than a few millimeters than intended, or using incorrect vector of pull, can lead to unnatural results or “weird expression.”


“Prudent patients should ensure that their plastic surgeons are board certified and have been performing the sought procedure on a regular basis,” he says.

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The standard brow lift technique uses an ear-to-ear incision across the top of the head, within the hair-bearing scalp. While it provides the most lifting effect, it comes with one major downside: Patients whose “starting” forehead is big may end up with a “five-head effect.”


People use the humorous term five-head to describe a forehead that is oddly large that five fingers can all fit on the space between the hairline and eyebrow, instead of just four fingers.


brow lift technique

Standard brow lift vs. endoscopic technique

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that most brow lift patients either want to maintain their forehead height or even slightly reduce it, making the standard technique inadvisable because it can elevate the hairline by up to 1 inch.


A hairline that is too high not just results in the five-head appearance, but it also has a masculinizing effect on the female face. Nonetheless, the standard brow lift remains ideal if the patient has a notably short forehead (which may sometimes lead to a primitive look) and desires to change this feature.


But for most patients, placing the incision precisely at the hairline, instead of inside the scalp, provides the most auspicious results—i.e., it maintains the hairline height or it can be even elevated if the patient wants to shorten her forehead.


The endoscopic technique is another type of brow lift that has no or very little effect on the hairline height; this often involves 4-5 tiny keyhole incisions placed behind the hairline. It favors patients with minimal forehead and brow sag.


With the right incision pattern based on the patient’s desired goals and starting anatomy, brow lift can provide natural looking effects. This is particularly true when the lateral brow or “tail end” is elevated, with no or very little change in the height of its medial or inner aspect.


To ensure that the scar remains hidden, all efforts are made to reduce the tension on the skin especially during the healing stage. Hence, most skilled surgeons use the horizontal and vertical mattress sutures so that the deeper structures carry most of the tension, instead of the skin.

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It may sound like a paradox, but the results of brow lift surgery primarily depend on the final shape, as opposed to the amount of elevation. In fact, lifting the eyebrows a few millimeters than intended can lead to a perennially surprised or quizzical look.


Hence, leading Beverly Hills plastic surgeon Dr. Tarick Smiley focuses more on improving the shape of the brow to achieve a more rejuvenated and youthful appearance without the dreaded classic signs of plastic surgery.


Several factors determine the ideal brow position and shape; these include the patient’s gender, ethnicity, and facial features. Nonetheless, certain “templates” or universal beauty standards do exist. For instance, female brows have a more arched appearance and more height compared with male brows.


Male brows, meanwhile, are more horizontally oriented and have less height—i.e., most of the bulk lies at the same level as the bony rim of the eye socket, or sometimes even slightly below this margin. But in female brows, they are deemed more attractive and youthful when they rest above this border.


Studies have shown that it is quite rare for patients to experience complete brow descent. In many cases, only the tail end or lateral aspect of their brow sags, while the medial or inner aspect remains barely unchanged despite advancing age and gravity.


However, inexperienced surgeons and antiquated techniques often elevate the entire brow, which almost always leads to unnatural effect. Sometimes, patients have no choice but to wait several years for their soft tissue to relax, ultimately reducing the effects of their botched surgery. Hence, Dr. Smiley emphasizes the importance of getting the surgery right the first time.


While the amount of elevation and the ideal shape will depend on several variables, Dr. Smiley says that female patients generally benefit from lifting the lateral or outer brow to resume a more arched appearance. The same principle also applies to male patients, although the lift should be done in a more conservative manner to avoid feminizing their face.


When reshaping the female brow, it should be noted that the apex of the arch should be at the same level as the lateral or outside border of the axis to ensure natural-looking results.


results of brow lift

The trichophytic brow lift is a new technique which does not alter the height of the hairline.

The success of brow lift will also rely on the scar placement, which depends on the incision technique. The standard method uses an incision that goes from ear to ear, a few millimeters above the hairline and so the hair conceals the resulting scar.


But the standard brow lift technique has an inherent problem: It elevates the hairline by about half an inch since doctors are forced to remove tissue from hair-bearing skin. Consequently, patients with a wide forehead may end up aggravating this appearance.


A new technique called trichophytic brow lift solves the intrinsic problem of the standard method since it uses incisions made precisely at the hairline and so the resulting scar blends into the background.

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Brow lift scar is one of the main concerns of patients who seek surgery to correct the appearance of their sagging brow or forehead. While scar is an inevitable tradeoff, a good surgeon will make every effort to position it in hidden areas, says Beverly Hills plastic surgeon Dr. Tarick Smiley.


Dr. Smiley says that one of the most influential factors affecting the final appearance of brow lift scar is the incision technique and placement.


brow lift scar

The scar from this hairline incision brow lift technique is expected to blend into the background.

In the past, most brow lifts were performed by creating an ear-to-ear incision that ran across the top of the head.


While the scar is placed behind the hairline, this antiquated technique ultimately raises the hairline to about an inch, which can lead to unnatural appearance particularly in patients with a high forehead.


Due to the inherent problems of the antiquated brow lift technique, Dr. Smiley says that he prefers the hairline incision method, or medically referred to as trichophytic.


The hairline incision causes no direct hair loss and removes only the excess skin from the forehead (instead from the scalp). The incision generally fades into a thin and undetectable scar, provided that proper wound closure has been used during surgery.


Instead of using one long straight incision, Dr. Smiley says a serrated incision (or zigzag) technique is more ideal during a hairline incision brow lift because it allows for good wound closure—i.e., no tension on the skin and so the scar generally fades nicely after a few months.


Furthermore, the serrated incision technique allows the hair to regrow naturally.


While the surgeon’s skillset, particularly involving his wound closure technique, plays a critical role in the appearance of brow lift scar, the patient’s commitment to recovery will also influence the final result. The consensus is to avoid sun exposure for a minimum of six months to prevent hyperpigmentation.


Hyperpigmentation happens when the scar darkens permanently after being exposed to UV rays. Hence, the use of protective clothing (e.g., large brimmed hat) and sunscreen is crucial to promote the most favorable scar possible (i.e., it blends into the background).


Many patients are also encouraged to use scar creams and other topical treatments containing silicone, which is known for its hydrating effects. A scar that heals in a moist environment is known to fade into the background.


Generally speaking, after a brow lift patients should expect 1-2 weeks of social downtime, i.e., no outward sign of the surgery.

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Brow lift results are supposed to look natural—i.e., there is no visible scar, the brows are positioned and reshaped based on critical factors such as gender and facial features, and the skin appears smooth with no or very minimal creases.


The traditional technique uses a long incision about 2-3 inches behind the hairline that goes from ear to ear. It allows the surgeon to remove a small piece of skin to correct the sagging appearance of the forehead and brow, eliminate the muscle tissue that is causing the creases, and reshape and reposition the brows.


brow lift results

But for additional support, experts at the California Surgical Institute suggest the use of fixation devices to re-suspend the forehead tissue and brow muscles. Some surgeons use Endotine (which is an absorbable prong-like device), permanent or absorbable sutures, or screws.


Endotine is particularly popular in Los Angeles plastic surgery due to its impressive safety record. This absorbable device has multiple prongs that secure the forehead tissue to the small hole in the forehead bone.


Before the body absorbs completely the Endotine system, a strong muscle adhesion is created between the brow tissue and the forehead bone. Hence, the results are perceived to be longer and more stable as compared to brow lift without any fixation device.

One of the disadvantages of this device is that it can be felt through the skin, at least temporarily. Also, it is a little more expensive than the other fixation devices.


Other surgeons prefer the use of permanent sutures to re-suspend the brow muscle and forehead tissue suggesting that this technique provides stronger support than Endotine and absorbable stitches.


Despite varying views on which provides the strongest support among the fixation devices, the truth is that the surgeon’s qualifications—i.e., board certifications, training, and experience—are more critical factors than his preferred “technologies” and techniques.


It is important to note that good brow lift results are primarily achieved by a high level of technical skills combined with artistic competence on the surgeon’s part. In addition, it is of critical importance that he understands the nuances between male and female surgeries and the gender-based ideals of beauty.


Medical literature suggests that the longevity of brow lift results greatly varies from patient to patient (3-10 years) not just because of the techniques utilized at the time of surgery. Skin elasticity, sun exposure, skin care regimen, diet, and smoking will all have their effects as well.

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