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A heavy eyebrow or forehead can be a sign of age but is not always directly related to the aging process. Some people are born with thicker or more pronounced soft tissues of the forehead. Regardless of the cause, a heavy brow can give the appearance of anger, frustration, or sadness – even when you’re feeling great. In addition, the full brow can push down on the upper eyelids, making you look tired or drowsy. (This heaviness on the outside of the eyelid area is called lateral hooding.) Finally, the shadow cast by the brow can detract from the brightness or openness of your eyes, again giving an impression that is different than how you feel.

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In many cases, Dr. Ransom can address these specific concerns with a minimally-invasive endoscopic browlift (forehead lift). However, certain circumstances demand a different approach – and Dr. Ransom is a specialist in all types of brow and forehead surgery. For patients with an asymmetric brow (one side obviously higher than the other), or in cases of facial paralysis (where one side of the forehead doesn’t move), open treatment of the forehead helps to achieve the best results. In women with a high hairline or tall forehead, an open approach may allow for hairline lowering or reduction of excess forehead skin, using an incision placed in the hairline (pretrichial browlift). For men with significant hair loss and a heavy brow, a variety of approaches can be used to elevate the brows without elevating the hairline or leaving obvious, unsightly scars in the scalp – ensuring natural-appearing results. For more information, see the Procedures for Men section.

Endoscopic Browlift

During an endoscopic browlift, the frown lines in between the eyebrows (glabellar rhytids, also called the “11’s”) can also be addressed – minimizing or eliminating the need for Botox® Cosmetic treatments to this region! With an endoscopic browlift, all of the incisions are placed behind the hairline – so that they leave no visible scars! Dr. Ransom uses these hidden access points to lift the soft tissues of the forehead and eyebrow region, while carefully maintaining the normal orientation of the eyebrow and ensuring natural-appearing rejuvenation.

The endoscopic browlift can be combined with other facial rejuvenation procedures and is particularly effective when the eyelids are addressed at the same time (with an upper eyelid and/or lower eyelid lift). Please visit the photo gallery for some examples.

Temporal Browlift

For some patients, heaviness is concentrated in the outer (lateral) portion of the brow – the area responsible for lateral hooding of the upper eyelids – while the center of the brow sits in a good position. In these cases, Dr. Ransom may recommend a temporal browlift, which lifts only the lateral portion of the brow. Small incisions are hidden within the hair of the temple region, and the tail of the eyebrow is gently elevated to restore a more open, rested appearance to the eyes.

Because a temporal browlift does not lift the center of the forehead, it can be a good option for patients with a high or receding hairline who want to avoid raising the hairline further. It is also frequently paired with an upper eyelid lift (blepharoplasty) to address both lateral hooding and excess eyelid skin at the same time. During your consultation, Dr. Ransom will evaluate your brow position, hairline, and eyelids to determine whether a temporal, endoscopic, or open approach is best for you.

Combining Procedures

Brow or forehead lifts, regardless of approach, can be combined with other facial rejuvenation or reconstructive procedures, and are particularly effective when the eyelids are addressed at the same time. Please visit the photo gallery for some examples.

Who is a candidate?

Anyone with a heavy brow, deep glabellar rhytids (the “11’s” between the eyebrows), and particularly patients with lateral hooding of the upper eyelids (see above) is a candidate. Special consideration is needed for men who are bald or have significantly receding hairlines (please visit the Procedures for Men section). Upper eyelid ptosis (upper lids do not open all the way) should not be confused with lateral hooding; this issue has to do with the muscles that retract the upper eyelid, rather than excess eyelid skin or a heavy brow region. Comprehensive rejuvenation of the entire forehead, brow, and eyelid complex can be discussed with Dr. Ransom at your consultation.

Medical Necessity: Forehead Osteoma Removal

Using the same hidden-incision, endoscopic approach to the forehead, Dr. Ransom also treats forehead osteomas. A relatively common and benign condition, osteomas are bony growths that form as hard knobs beneath the skin. Though they can exist anywhere on the skull or face, osteomas frequently occur between the hairline and eyebrow region. While some individuals report pain, headaches, or sight issues, osteomas are more of an eyesore than a major health concern. Surprisingly, many live with osteomas for many years because they do not realize that osteoma removal is a minimal, outpatient procedure with little downtime.

Forehead osteoma removal may be performed by making a small buttonhole incision just inside the hairline or scalp. The bone is then reshaped using an endoscopic procedure, where excess osteocytes (bone cells) are removed. The endoscopic approach is of great benefit to patients because the point of access is hidden in the hairline, resulting in no visible scarring. This less invasive technique swiftly removes the osteoma (in less than 30 minutes) in one outpatient visit, and the result is a forehead that is smooth, with no signs of surgery or scarring.

Dr. Ransom, a renowned San Francisco brow lift surgeon, sees patients from all over Bay Area, including Mill Valley/Marin County, Napa/Sonoma, San Rafael/Petaluma, Hillsborough, San Mateo, Menlo Park, Orinda, Palo Alto, Piedmont, Walnut Creek, and the world.

Frequently Asked Questions

Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.

How long do brow lifts last?

A browlift, like most procedures for facial aging, is permanent. However, the face will continue to age. Over time, patients may desire to repeat the browlift. This is typically after 10 years or more. Some brow lift techniques have a shorter lifespan -- for example, brow lifts performed with threads may last only a few months.

What is a direct brow lift?

Direct browlift is a procedure to lift the brows that involves removal of skin in the forehead immediately above the eyebrows. This is used most commonly in cases of forehead paralysis and is also a good option for bald men.

What is a mini brow lift?

A mini browlift is a term used to describe a procedure to lift the brows that is performed with minimal incisions.

Can a brow lift be done under local anesthesia?

Yes, certain types of browlift can be performed under local anesthesia. Most browlifts are performed with other facial cosmetic procedures which may necessitate sedation or general anesthesia.

Does a facelift include a brow lift?

In the modern world of plastic surgery, facelift generally means a lift that includes the cheeks and jowls/jawline. Browlift and neck lift are often performed with a facelift; however, these would need to be specified as part of the surgical plan.

Does insurance pay for brow lift?

In rare cases where brow ptosis is due to a medical condition or when the brow heaviness obstructs vision, insurance may pay for a brow lift. In our practice, we do not bill insurance for these procedures.

How can I raise my eyebrows in one day?

For a quick fix to mild brow ptosis, Botox Cosmetic injections are the easiest solution. A so-called chemical browlift uses small doses of Botox arund the eyes and in the forehead to allow for lift of the tail of the eyebrows.

Is eyebrow lift dangerous?

Browlift is a safe procedure, though complications are possible. Bleeding under skin (hematoma) is the most common problem. This is treated by drainage of the blood and/or placement of a drain. Weakness of the forehead muscle can also occur; this is from bruising or injury of the nerve that controls forehead movement. In most cases, this is a temporary problem and will recover in a few weeks to months.

What age should you get a brow lift?

There is not a best age for a browlift. This surgical procedure treats a specific anatomical issue -- a flat or ptotic brow. Some patients will have this procedure as early as their 30s, while others may never need it.

What can I expect after a brow lift?

After a brow lift, there is generally some bruising and swelling in the forehead and temple region. There can be puffiness around the eyes as well. Patients often experience some discomfort or headache, as well as a feeling of tightness. This generally resolves in a few days.

What is endoscopic brow lift?

An endoscopic browlift uses small incisions and an endoscope to perform the browlift. The endoscopic portion is typically for resection or ablation of the corrugator muscles. This has become less popular over time as it can lead to separation of the brows in the midline and too much lift of the medial brow.

What is the difference between a brow lift and blepharoplasty?

Brow lift is a procedure to lift the eyebrows. Blepharoplasty is a procedure to treat the eyelids (upper or lower).

Does a brow lift get rid of forehead wrinkles?

No. Browlift surgery is meant to lift the eyebrow (and has a mild effect on the upper lids). The forehead muscles will continue to work and therefore dynamic wrinkles (those caused by motion) will still occur.

How can I lift my eyebrows?

For patients with mild brow ptosis and forehead lines, Botox Cosmetic injections are the simplest way to improve the brow region. In cases that are too advanced for this treatment, a surgical browlift would be indicated.

How long does numbness last after brow lift?

Numbness of the scalp after browlift is common. The degree and location of numbness will depend on the type of browlift performed, and specifically on the location of the incisions used.

How much does a brow lift cost?

Browlift costs vary by technique, surgeon, and location. In addition, the setting (office vs. surgery center) and anesthesia type (sedation vs. general) will affect the costs.

Is eyebrow lift surgery painful?

Many patients will experience some pain or headache after browlift surgery. This is temporary and can be treated with oral medications.

When can I wash my hair after brow lift?

In most cases, patients can wash their hair 48 hours after browlift. Conditioner and other hair treatments must be avoided.

Will brow lift cause hair loss?

It is possible to have some hairloss (allopecia) from a brow lift due to tension on the scalp or compromise of the vascularity of the hair follicles. This is uncommon.

Does brow lift change eye shape?

Browlift does not change the eye shape. Rather, browlift is meant to lift the brow and create more of an arch.

Does endoscopic brow lift raise hairline?

Endoscopic browlift can raise the hairline in some patients. For those with a high hairline before surgery, a different approach may be preferred. This includes tricophytic browlift (hairline incision) or temporal browlift (lateral portion only).

How do I know if I need a brow lift?

If your brow hairs are sitting on the brow bone edge (for women) or below this (for men), a browlift may be indicated.

How much is a brow lift?

Browlift changes are permanent. However, the face and brow region will continue to age over time.

Can I have a brow lift if my hairline is receding?

Patients with receding hairlines, shaved heads, or baldness can still have brow lifts by moving the incisions laterally into the temporal hair or placing them along upper forehead wrinkles. This surgery usually uses four small (about one centimeter) incisions placed around the midline and sides to camouflage scars and secure the full brow lift.

Will a brow lift change the shape of my eyes?

A brow lift does not change the shape of the eyes. While the eyes may appear more open or fuller, the actual eye shape is determined by the lateral and medial canthus—the points where eyelid skin and muscle attach to the orbital bone—and this structure is not altered by a brow lift unless specifically addressed.

How long does it take to recover from brow lift?

After a brow lift, patients often feel mild headaches or pressure around the forehead and eyes due to tissue release, which is usually eased with NSAIDs, pain medication, or sometimes low-dose anti-anxiety meds, though not everyone experiences these symptoms. Swelling and bruising around the eyes are common and typically last 7 to 10 days as the tissues heal from the procedure that releases tissue around the orbital rim and cheek.

Do I need an eyelid lift or a brow lift?

Many patients ask whether they need a brow lift or an eyelid lift, which is best determined by a surgical consultation. In general, eyelid lifts remove excess skin, while brow lifts raise forehead tissue that can weigh down the eyelids—especially helpful for those with forehead heaviness but little eyelid skin excess.

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Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.

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