The Condition
Brow ptosis (descent) is a normal feature of facial ageing, exacerbated by repeated forehead muscle activity. Descent of the lateral brow in particular produces a hooded, tired or angry appearance. Forehead lines and deep glabellar furrows develop concurrently. Heavy brows may worsen upper eyelid hooding and occasionally contribute to visual field impairment.
Surgical Options
Endoscopic brow lift: Small incisions within the hairline; an endoscope (camera) allows visualisation and precise release of brow-depressing structures. Brow suspension is achieved with internal fixation (e.g. Endotine device). Minimal scarring, natural results. Best suited to patients with adequate forehead height. The same endoscopic, hidden-incision approach can be extended down into the midface — see Endoscopic Midface Lift for patients whose main concern is cheek and midface descent rather than the brow alone.
Temporal brow lift: Incisions within the temporal hairline to elevate and secure the lateral brow. Simpler procedure, shorter recovery; ideal for lateral brow descent.
Direct brow lift: Incision placed directly above the brow in suitable patients (particularly men with deep forehead lines). Precise control of brow position; scar usually concealed within eyebrow.
Who Is a Good Candidate?
Not everyone with tired-looking eyes needs a brow lift — heavy or hooded upper eyelids can equally be caused by excess eyelid skin rather than true brow descent, and the two are assessed separately at consultation.
Indications: Genuine brow descent (rather than eyelid skin excess alone) causing a hooded, tired or angry appearance; forehead lines and glabellar furrows; adequate forehead height for the endoscopic approach.
Contraindications: A high, receding hairline may make incisions harder to conceal with an endoscopic approach; active smoking; unrealistic expectations of a permanently "fixed" result, given some relapse is expected over time.
The Procedure
Endoscopic brow lift is performed under general or deep sedation anaesthesia. Small 1cm incisions are placed within the hairline. The forehead is elevated, brow-depressors released and the brow suspended in its new position. Operating time 1.5–2 hours. Often combined with upper blepharoplasty.
Risks & Complications
Numbness
Forehead numbness common initially; usually resolves over 3–6 months.
Alopecia
Temporary shedding near incisions; permanent hair loss uncommon.
Asymmetry
Minor asymmetry common; significant asymmetry requiring revision uncommon.
Brow Over-elevation
Surprised appearance if over-corrected; conservative elevation preferred.
Relapse
Some degree of recurrence is expected over time; results typically last 5–8 years.
Frontal Nerve Injury
Temporary frontal branch weakness possible; usually resolves.
Aftercare & Recovery
- Shower after 48 hours; wash hair gently
- Sutures/staples removed at 7–10 days
- Swelling and bruising: substantially resolved at 2 weeks
- Return to office work: 7–10 days
- Exercise: light at 2 weeks; strenuous at 6 weeks
- Swimming/sauna: 2 weeks post-healing
- Contact sports: 6 weeks
Alcohol impairs platelet function and increases bleeding risk, interferes with anaesthetic agents requiring higher doses, impairs wound healing by reducing collagen synthesis and immune function, and increases infection risk. Abstain completely for at least two weeks before and two weeks after surgery.
Nicotine causes vasoconstriction, dramatically increasing risk of wound breakdown, skin necrosis, poor scarring and infection. This includes cigarettes, vaping, patches and gum. Mr Naparus requires patients to be nicotine-free for a minimum of six weeks before and six weeks after surgery. In procedures such as facelift, active smoking is an absolute contraindication.
Absorbable sutures (Vicryl Rapide, Monocryl) dissolve over days to weeks. Non-absorbable sutures (Prolene, nylon) are removed at 5–7 days on the face or 10–14 days elsewhere. You will be clearly advised which has been used.