Brow ptosis and brow lift
Brow ptosis is descent of the brow with age or nerve weakness. The lowered brow pushes onto the upper lid and looks like lid excess. Removing lid skin alone can pull the brow even lower, so brow position is part of every upper lid examination.
What is brow ptosis?
The brow is held up by the forehead muscle. With age, tissue laxity, gravity and changes in the underlying bone bring the brow down, usually more at its outer tail. Less often, a one-sided drop follows facial nerve weakness.
People whose brows have dropped often raise them without noticing, which causes horizontal forehead lines and forehead fatigue by the end of the day.
How it differs from upper eyelid surgery
When the brow drops, its skin is pushed onto the upper lid and looks like lid skin excess. If only lid skin is removed:
- the brow can be pulled even lower towards the incision,
- the distance between brow and lashes shortens and the look can become heavier,
- the lid can look full again once the patient stops raising the brows.
Brow position is therefore assessed with the forehead relaxed. When brow descent and lid excess occur together, both are often treated in the same session. See upper eyelid surgery.
Brow lift methods
- Direct brow lift: the incision is made along the upper edge of the brow. It is the more commonly preferred method, as the brow can be lifted to the desired height and shape with more control. The scar sits at the upper border of the brow.
- Internal browpexy through the upper lid incision: the brow is supported from inside during upper lid surgery, with no additional scar. It helps prevent further descent in mild cases.
- Temporal lift: the outer brow is lifted through incisions in the temporal hairline. A scar may remain in the temple area, and the brow may not always be lifted as much as desired.
- Endoscopic brow lift: done through several small incisions in the scalp with a camera, when the whole forehead and brow need lifting.
Botulinum toxin injected into the muscles that pull the brow down can give a small, temporary lift of the brow tail. It does not replace surgery for marked brow ptosis.
Recovery and risks
Swelling and bruising usually settle within one to two weeks. Risks include asymmetry, temporary numbness of the forehead or scalp, scar visibility and, rarely, injury to the nerve branch that moves the forehead. The method is chosen according to how far the brow has dropped, the hairline, skin type and the patient's preferences about scars.
Frequently asked questions
Can a brow lift and upper eyelid surgery be done together?
Yes. When brow descent and lid excess occur together, both are often planned in the same session.
Does botulinum toxin lift the brow?
It can give a small, temporary lift of the brow tail. It does not replace surgery for marked brow ptosis.
Will my forehead feel numb?
Some methods can cause temporary numbness of the forehead or scalp, which usually resolves within months.
References
This page is for general information only and does not replace a medical consultation. Anatomy and treatment plans differ from patient to patient.