Brow Lift

Part of our complete guide to Upper Facial Aging — this page covers brow lift surgery in depth.

What is a Brow Lift

A brow lift (forehead lift) is a surgical procedure to elevate a descended brow to its natural resting position above the orbital rim. As the forehead and brow tissues descend with age, the brows may fall below the supraorbital rim, imparting a tired, heavy, or angry appearance. Brow ptosis can also mimic or worsen upper eyelid skin excess, and it is essential to evaluate brow position before performing upper blepharoplasty.

Anatomy of the Brow

The brow complex consists of skin, subcutaneous fat, the frontalis muscle, the galea aponeurotica, and the periosteum of the frontal bone. The frontalis is the only elevator of the brow; the corrugator, procerus, and depressor supercilii are antagonist depressors.

• Normal brow position (female): The brow begins medially at or just above the supraorbital rim, arches upward, and peaks at the lateral limbus or lateral canthus. The lateral brow sits higher than the medial brow.
• Normal brow position (male): Flatter, at or just at the supraorbital rim, with less lateral arch.
• Sensory supply: Supraorbital and supratrochlear nerves exit foramina along the superior orbital rim and supply the forehead and scalp. These must be protected in all brow lift techniques.
• Motor supply: The frontal branch of the facial nerve (VII) courses within the temporoparietal fascia as it crosses the zygomatic arch and ascends over the temple and is the critical structure at risk in temporal approaches.

Coronal Brow Lift

The coronal brow lift uses an incision placed from ear to ear across the top of the scalp, 5–6 cm behind the hairline. It provides the most powerful and predictable elevation of the entire brow and forehead, and allows direct access to the corrugator and procerus muscles to reduce glabellar frown lines.