Brow lift · New York and New Jersey
Brow lift
A brow lift raises brows that have dropped and smooths the forehead, so the eyes look open and rested again. Dr. Steven Ovadia is a board certified plastic surgeon with fellowship training in craniofacial surgery, with offices in New York City and New Jersey.
Overview
What a brow lift is
A brow lift, also called a forehead lift, is surgery that raises the brows and smooths the forehead. With age, the skin and the layer under it loosen, and the brows drop toward the eyes. The upper lids look heavy, the outer corners of the eyes hood over, and the forehead creases from years of lifting the brows to see.
A brow lift corrects this where it starts. The forehead is released from the bone, the brows are raised to where they used to sit, and the muscles that pull them down and make the frown lines can be weakened. The eyes open, and the tired or stern look that low brows give goes away.
The goal is that you look like yourself, rested, with brows that sit naturally and a forehead that still moves.
What a brow lift treats
- Brows that have dropped, so the eyes look smaller or tired
- Heaviness of the upper lids that comes from the brow, not the lid
- Hooding at the outer corner of the eyes
- Horizontal lines across the forehead
- The frown lines between the brows
- A flat or downturned shape to the brow
What a brow lift does not do
- Remove extra eyelid skin. Blepharoplasty does that
- Treat bags or loose skin under the eyes
- Lift the cheeks, jowls, or neck. A facelift does that
- Change the quality of the skin itself
- Stop the forehead from moving. The muscles are weakened, not removed
Tell Dr. Ovadia about high blood pressure, blood thinners, aspirin, supplements, and any nicotine use, including vaping. These affect bleeding and healing, and they are planned for well before surgery.
Approaches
The ways a brow lift is done
Every brow lift does the same thing: the brow is freed from the bone and moved up, and held at its new height. The approaches differ in where the incision is and in how much lift they give. Which one is right for you depends on your hairline, on how far the brows have dropped, and on what you want to change.
These are the approaches you are most likely to come across. Dr. Ovadia performs four of them. The others are listed below so you know what they are, though he does not currently offer them.
Performed by Dr. Ovadia
Transpalpebral browpexy
Through the upper eyelid
The brow is lifted through the same incision as an upper blepharoplasty, in the crease of the upper eyelid. Working up from the eyelid, the brow is freed from the bone and stitched to the bone lining of the forehead at a higher point. There is no incision in the scalp or at the hairline.
Suits a brow that has dropped a modest amount, usually the outer brow, in someone having upper eyelid surgery at the same time.
Hairline brow lift
Along the hairline
The incision runs along the front edge of the hairline, right where the hair begins, and moves back into the hair at the temples. The forehead is lifted and a strip of forehead skin is removed, so the brows come up without the hairline moving back. The hairline can be lowered at the same time.
Suits a high forehead or a receding hairline, and a brow that has dropped more than a browpexy can correct. Also called a pretrichial brow lift.
Coronal brow lift
Ear to ear, in the hair
One incision across the top of the head, from ear to ear, well behind the hairline. The whole forehead is lifted and a strip of scalp is removed, so the scar is hidden in the hair. It raises the hairline a little.
Suits a low or normal hairline and a brow that has dropped a great deal, when the most lift is needed.
Direct brow lift
Just above the brow
The incision is placed right along the upper edge of the eyebrow, or in a deep forehead crease, and a strip of skin above the brow is removed. It gives the most control over the height and shape of each brow, with a scar that sits in the open and fades into the edge of the brow.
Suits deep forehead creases, thinning hair, a brow that droops on one side, or when the simplest operation is wanted.
Other approaches, not currently offered by Dr. Ovadia
Endoscopic brow lift
Small incisions in the hair
Four or five short incisions behind the hairline. A small camera and thin instruments release the forehead, and the brows are held at their new height with sutures or small anchors.
Temporal brow lift
Short incisions at the temples
One short incision in the hair at each temple lifts the outer third of the brow. The middle of the forehead is left alone.
The approach for your surgery is part of your surgical plan. Dr. Ovadia goes over it with you at your consultation, after examining your brows, your eyelids, and your hairline.
How it is done
Incisions
The incisions are placed according to the approach: in the crease of the upper eyelid, along the hairline, in the hair across the top of the head, or just above the brow. Where they go is decided with you before surgery.
The forehead is released
The skin and the layer under it are freed from the bone of the forehead and brow, so they can move. The muscles that pull the brows down and make the frown lines may be weakened.
The brows are lifted
The forehead, or the brow itself in a browpexy, is moved up and the brows are set at their new height and shape. Each side is set on its own, so a brow that sits lower than the other can be matched.
Held in place
The lifted brow is held with sutures to the bone lining or small anchors in the bone, and the incisions are closed with fine sutures, staples, or clips.
Incisions
Where the incisions are
A transpalpebral browpexy leaves no new scar at all: it is done through the upper eyelid crease, the same incision as an upper blepharoplasty. A hairline incision runs along the front edge of the hairline and heals as a fine line that the hair grows through. A coronal incision is in the hair across the top of the head, where it is hidden once it has healed. A direct brow lift is the exception: its incision sits just above the eyebrow, in the open, and is chosen when that trade-off is worth it.
The skin is closed without tension, which is what lets the scars heal as fine lines. Care is taken to keep the hairline in its natural position, and to avoid thinning of the hair along the incisions.
This is where the incisions are usually placed for each of the four approaches Dr. Ovadia performs. They are not the same for everyone: the placement depends on your anatomy, your hairline, and the amount of lift that is needed, and other incisions are sometimes used. Dr. Ovadia shows you where your incisions will be when he goes over your surgical plan.
Brow lift or eyelid surgery
Is it the brow or the eyelid?
Heavy upper eyelids are the most common reason people ask about a brow lift, and the most common reason they ask about eyelid surgery. The two look similar from the front but come from different places, and the wrong operation does not fix the problem.
A simple test: look in a mirror and gently lift your brow with a finger. If the heaviness of the lid goes away, the brow is the cause. If the extra skin is still there, it is on the lid itself.
The brow sits low
Brow lift
If the brow itself has dropped toward the eye, the heaviness of the upper lids comes from above. Removing eyelid skin alone does not fix it, and can pull the brow lower.
The lid skin is loose
Blepharoplasty
If the brow is in a good position and the extra skin is on the lid itself, eyelid surgery is the right operation.
BlepharoplastyBoth
Often done together
Many people have some of each. A brow lift and an upper blepharoplasty are often done at the same operation, with less eyelid skin removed because the brow lift has already opened the eye. A transpalpebral browpexy is done through the blepharoplasty incision itself.
Every surgery has risks. For a brow lift these include bleeding, infection, slow healing, numbness or itching of the forehead and scalp, thinning of the hair along the incisions, a brow that sits higher on one side than the other, weakness of the forehead from injury to a nerve, scarring, a raised hairline, and the need for revision surgery. Healing problems are more likely in people who use nicotine. Dr. Ovadia goes over the risks with you at your consultation.
Recovery
What to expect after a brow lift
Swelling and bruising are normal and expected
The forehead and the area around the eyes are swollen and bruised at first. Most people are comfortable being seen in public at 10 to 14 days. The last of the swelling takes a few months to settle.
An elevated head
Sleeping with the head of the bed elevated is important. Cool compresses help with swelling in the first days. A light head dressing may be worn for the first day or two.
Temporary numbness is common
The forehead and the top of the scalp can feel numb, tight, or itchy. This is from the nerves being stretched during surgery. Sensation typically returns gradually over the following months, though in some people a small area stays numb.
Sutures, staples, and clips
Sutures typically come out at 5 to 7 days. Staples and clips in the hair typically come out at 7 to 14 days. The hair can be washed gently after the first few days.
The forehead moves less at first
The forehead can feel stiff and move less for the first weeks. This settles as the swelling clears and the muscles recover.
Results come gradually
The brows sit a little higher than their final position at first, which is intended. They settle over the following weeks, and the scars start out pink and fade over the following months.
Normal swelling comes on slowly. A rapid increase in swelling is something to watch for, and it should be brought to your physician's attention right away. The same is true of swelling that is much greater on one side than the other.
A general timeline
This is a general guide. Everyone heals differently. During your recovery, Dr. Ovadia will review your timeline with you.
Cost
Cost and insurance
A brow lift is usually cosmetic surgery, and insurance is unlikely to cover it. The cost depends on the approach, on whether it is done together with eyelid surgery or other procedures, where the surgery is done, and the anesthesia. We go over it with you once your surgical plan is set.
When a brow lift may be covered
When the brows have dropped far enough to block the upper part of your vision, a brow lift may be covered. Plans that cover it usually ask for photographs showing the brow and lid skin over the eye and a visual field test showing that your vision improves when the brow is lifted. Our office can tell you what your plan requires.
If you have questions about the cost of surgery, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
Craniofacial surgery is surgery of the bones and soft structures of the face and skull, and the forehead and brow are at the center of it. He performs brow lift surgery on its own and together with eyelid surgery, a facelift, other facial surgery, and facial feminization surgery, where a brow lift is done through the same incision as the forehead contouring. He sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about brow lift surgery
What does a brow lift do?
A brow lift raises brows that have dropped and smooths the forehead. It opens the eyes, lifts hooding at the outer corners, and softens the tired or stern look that low brows give. The muscles that make the frown lines between the brows can be weakened at the same time.
How do I know whether I need a brow lift or eyelid surgery?
Look at where the brow sits. If it has dropped toward the eye, the heaviness of the upper lids comes from above, and a brow lift is the right operation. If the brow is in a good position and the extra skin is on the lid itself, blepharoplasty is. Many people have some of each. Dr. Ovadia examines your brows and eyelids at your consultation and tells you which would give you the change you are looking for.
Which brow lift approach is best?
There is no single best approach. A transpalpebral browpexy, done through the upper eyelid incision, gives a modest lift with no scalp incision and suits someone having upper eyelid surgery anyway. A hairline brow lift suits a high forehead, because the brows come up without the hairline moving back. A coronal brow lift gives the most lift, with the scar hidden in the hair. A direct brow lift, just above the eyebrow, gives the most control over each brow at the cost of a visible scar. The right one for you depends on your hairline, how far the brows have dropped, and what you want to change, and Dr. Ovadia goes over it with you when he plans your surgery.
Do you offer endoscopic brow lifts?
Not currently, and he does not currently offer temporal brow lifts either. Dr. Ovadia performs the transpalpebral browpexy, the hairline brow lift, the coronal brow lift, and the direct brow lift. Between them they cover a modest lift with no scalp incision, a lift that keeps or lowers the hairline, the most lift for a brow that has dropped a great deal, and the most control over each brow.
Where are the scars?
For a transpalpebral browpexy, in the crease of the upper eyelid, the same scar as an upper blepharoplasty. For a hairline brow lift, along the front edge of the hairline, where the scar heals as a fine line that the hair grows through. For a coronal brow lift, across the top of the head in the hair, where it is hidden. A direct brow lift leaves a scar just above the eyebrow. Dr. Ovadia shows you where your incisions will be.
Will I look surprised?
A surprised look comes from raising the brows too high, or from raising the inner brow more than the outer. The goal of a brow lift is to put the brows back where they used to sit, with the outer brow a little higher than the inner, so that you look like yourself, rested rather than startled. The brows are set slightly higher than their final position at surgery because they settle a little as the swelling clears.
Will my forehead still move?
Yes. The muscles that pull the brows down and make the frown lines may be weakened, but they are not removed, and the forehead keeps its expression. It can feel stiff and move less for the first weeks after surgery.
Will my hairline move?
It depends on the approach. A transpalpebral browpexy does not touch the hairline. A hairline brow lift keeps the hairline where it is, or brings it forward if you want. A coronal brow lift raises the hairline a little, which matters more when the forehead is already high. A direct brow lift does not touch it.
How long does a brow lift last?
The result is long-lasting. The forehead keeps aging from its new starting point, so you continue to look younger than you would have without surgery. Sun protection and not smoking help the result last.
What is the best age for a brow lift?
There is no single right age. What matters is where your brows sit, what you want to change, and your health. Some brows sit low from a young age; most drop gradually with time.
Can Botox do the same thing?
Botox and similar injections relax the muscles that pull the brows down, which can lift the brows a little and soften the forehead and frown lines for a few months at a time. They do not move a brow that has dropped a significant amount, and they do not remove loose forehead skin. They can be useful before a brow lift is needed, or alongside one.
How long is the recovery?
Most people are comfortable being seen in public at 10 to 14 days, once the sutures and staples are out and most of the bruising has faded. Numbness and itching of the forehead and scalp typically take a few months to settle, and sensation typically returns. Everyone heals differently.
Can a brow lift be combined with other surgery?
Yes. It is often done together with upper or lower eyelid surgery, a facelift, or fat grafting to the face. Whether it is safe to combine procedures depends on your health and how long the operation would be.
Does insurance cover a brow lift?
A brow lift is usually cosmetic surgery, and insurance is unlikely to cover it. When brows have dropped far enough to block the upper part of your vision, a brow lift may be covered, with photographs and a visual field test as documentation. Our office can tell you what your plan requires.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey.
Next step
Start with a consultation
Dr. Ovadia will examine your brows, eyelids, and hairline, go over what you are hoping to change, and explain what a brow lift, eyelid surgery, or a combination would do for you.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com