Is the Browlift Dead?

The browlift hasn’t completely gone the way of the dinosaurs, but some surgeons feel it is nearing the brink of extinction. “I came up in the era of everybody doing browlifts—I’ve done thousands myself—but it’s not an operation I enjoy, because most of the time, I don’t like how it looks,” says Corona Del Mar, CA plastic surgeon Val Lambros, MD. What commonly happens with both endoscopic browlifts and traditional open browlifts, which are almost never done anymore, he adds, is “the middle of the brow winds up higher than the sides, because of the effect of the squint muscles, and this gives patients a permanently plaintive or anxious kind of look.”

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Better Ways to Raise
Chicago plastic surgeon Julius Few, MD, who still performs the occasional browlift, also acknowledges the procedure’s waning popularity: “So many people were surgically overelevated, and there was backlash.” People began seeking less-aggressive but still powerful alternatives, like neuromodulators, which in the hands of skilled injectors can tackle many of the same issues, smoothing horizontal creases and deep frown lines while subtly hiking key aspects of the forehead and brows. Of course, toxins, too, can be overdone, notes Dr. Few, creating troubled expressions all their own. In a move against deadened foreheads and Spock brows, “I now treat very few foreheads with Botox,” he says. “I’ve found that if we target the crow’s-feet area, and we treat the 11s between the eyebrows, the brows tend to sit more naturally, and you create a secondary relaxation of the forehead lines without ever injecting the forehead itself.” (This is somewhat of a new technique, and not every injector will approach the forehead the same way.)

According to Dallas plastic surgeon Rod J. Rohrich, MD, strategically placed micro-fat grafts can sometimes serve as a solid stand-in for surgery. We naturally lose fat in the face with age, and this contributes to brow sagging. “In many cases, all you need to do is replenish the forehead and temples, and it looks like you’ve had a browlift,” he says. 

Still, needles aren’t an unanimous fix. “If the brows are low and the patient can’t get a good result with injectables, then there is a role for a surgical browlift,” explains  La Jolla, CA plastic surgeon Robert Singer, MD. “I choose to look at it as more of a forehead redraping— smoothing it without really lifting or changing the hairline or brow position.” Some patients may also benefit from a creative combo: a light dose of neurotoxin in the mid-forehead and a lateral browlift (with an incision back behind the hairline) to elevate the tails of the brows and keep them from falling and creating laxity. 

In looking to the future, Dr. Few adds, “I think there will be a wave of suture technologies that will be better and more effective [than surgery] to lift the brow. We’re still trying to figure out the best way to do that, so we’re not there yet, but it’s an exciting prospect.”

If you’re bothered by an aging forehead, it pays to act early. Because once a slumping brow begins infringing upon the eyes, turning lids heavy or hooded, eyelid surgery (aka blepharoplasty) can become an integral part of the solution.