Direct Eyebrow Elevation

Direct brow elevation is an effective technique to elevate either the entire horizontal brow (full direct brow) or simply the tail or temporal aspect of the brow (temporal direct brow). Aesthetic and functional indications for direct brow elevation include improvement of the superior visual field, enhancement of the upper face by relieving falsely conveyed emotions (e.g., sadness with temporal brow ptosis, anger with medial brow ptosis, or tiredness/sleepiness with full brow ptosis), relief of eyelash ptosis from excess dermatochalasis, and a decrease in chronic frontalis overaction, which may lead to headaches. Direct brow elevation is functionally effective in all patients, and while this approach is not technically challenging, wound construction and closure is paramount to achieve an acceptable cosmetic outcome. The surgical scar is best camouflaged in those with thicker eyebrow hairs and may be visible postoperatively even with flawless technique. For these reasons, this procedure should be performed only after a careful discussion of the risks, benefits, and desired patient outcomes with a clear postoperative plan for possible visible scar management, including adjunctive therapies or planned makeup usage.