Upper eyelids, brow lift or forehead lift?

What are the differences between upper eyelid surgery, eyebrow lifts and brow lifts? And what different options and techniques are there for these procedures, and when is it appropriate to consider each option? In this article we will take a closer look at the different types of reconstructive surgery for the upper eyelids, eyebrows and forehead.  

The skin of the upper eyelid loosens over time and gradually begins to droop toward the field of vision, causing not only aesthetic problems but also functional problems. Often, the position of the eyebrow also drops with age, pushing the upper eyelid downwards. In fact, when we talk about a forehead lift , we are usually referring specifically to an eyebrow lift. 

Other reasons for forehead lifts may include a high hairline that needs to be brought forward or a low hairline that needs to be raised slightly. No forehead lift surgery is permanent, and wrinkles caused by muscle activity often return over time. 

Upper eyelid surgery  

Most adults have slightly loose skin on their upper eyelids. The amount of loose skin increases as we age, but some people may develop excess skin folds at a very young age. The majority of patients already experience functional symptoms, which are often caused by muscle tension. Muscle tension, in turn, is the result of constantly raising the eyebrows to compensate for the looseness of the upper eyelids. 

Upper eyelid surgery is a quick procedure performed under local anaesthesia, in which loose skin is removed and, if necessary, the fat pads of the upper eyelid are trimmed slightly. This reduces the fullness of the upper eyelid. Upper eyelid surgery is also suitable for patients who already have drooping eyebrows, either in combination with or separately from eyebrow lift surgery. 

(Read more about upper eyelid surgery here) 

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Eyebrow and forehead lift surgery  

If the cause of excess tissue on the upper eyelid is primarily drooping eyebrows, upper eyelid surgery alone will not be sufficient. Eyebrow lifts are also performed for purely aesthetic reasons to change the shape and position of the eyebrows. The following is a list of different ways to lift the eyebrows and forehead.

Pexia l. fastening  

The eyebrow is attached to the brow bone through an incision made during upper eyelid surgery. Works better as a preventive measure or in mild cases at most.   

Open brow lift  

The incision, and therefore also the scar, is placed on the eyebrow as close to the eyebrow as possible. The disadvantage is that the scars are often visible, but they fade well over time, especially on mature faces. 

Gliding brow lift  

The skin is released up to the eyebrow through the hairline, after which the eyebrow is attached to its new position by suturing. A small, invisible scar remains at the hairline. A mesh-like suture is placed on the surrounding skin, which is removed after two days. The "mesh" leaves no visible marks, even though it may look a little rough at first. Gliding brow lift is effective for lifting the outer edge of the eyebrow and can also be used to change the position of the eyebrow for aesthetic purposes (see picture). 

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Endoscopic forehead lift  

Small scars will appear at the hairline, but these will practically disappear as they heal. During the operation, all the tissue is detached from the base, i.e. the bone, after which the entire forehead can be lifted and tightened, raising the eyebrows at the same time. An endoscope is used to ensure that the nerves in the forehead remain intact. The procedure is not too well suitable for patients who already have a high hairline, as the hairline often rises slightly as a result of the surgery. The surgery is performed under general anaesthesia and takes 1–2 hours. Patients usually recover in just over a week, depending on the amount of bruising. 

Open forehead lift  

The surgery is otherwise quite similar to the endoscopic procedure described above, but in open lifting, as the name suggests, an incision is made either at the hairline (if the hairline is to be lowered or not raised at all) or behind it (if the hairline is to be raised). The tissue is lifted in the same way as with an endoscope, and finally the excess skin from the forehead or scalp is removed. The scar heals to the point of being virtually invisible, and the recovery time is the same as with an endoscope. In the endoscopic technique, the tissue is moved up and back as a whole, while in the open technique, the excess tissue is removed. 

Other things to consider regarding eye area surgery  

The entire eye area should always be assessed as a whole, rather than focusing solely on the upper eyelids, for example, which is sometimes the case. The assessment of the eye area also includes the lower eyelids, which, when they sag, can affect both the aesthetics and functionality of the entire area. It is advisable to consult a plastic surgeon who is familiar with facial surgery so that the right surgical plan can be tailored to the patient's needs. 

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Atte Manninen  

Plastic surgeon 

Specialist in ear, nose, and throat diseases