What the research shows
Combining procedures is safe. In a multicenter insurance database, about 1 in 250 cosmetic eye surgery patients had a major complication, with no increase when a brow lift was added to eyelid surgery; hematoma was the most common problem (Wormer 2023).
A brow lift raises the brow by a few millimeters that last, most at the outer end. A 2026 pooled analysis found no difference between an incision at the hairline and one behind it; small implants held more lift at the outer brow than stitches but caused more abnormal sensation (Karanfilian 2026). Endoscopic lifts held their height in long-term studies (Şibar 2025).
Open and endoscopic lifts give similar results with different side effects. A review found no evidence that open lifts do worse (Graham 2011), and both kept the brow up an average of six years later with satisfied patients (Aslan Gülbitti 2022). Open lifts left more scalp numbness at first; it faded, and nearly every patient said the numbness would not stop them having the surgery again (Guillot 2011). An incision at the hairline kept the hairline in place, while the hairline moved back over the years after endoscopic lifts (Guyuron 2014). Endoscopic lifts carried a wider range of complications (Byun 2013). In a long-term endoscopic series, satisfaction was high early and lower years later, mostly in patients whose brow was not raised enough; few needed a second operation (Kashkouli 2022).
Upper eyelid surgery alone pulls the brow down slightly. An internal stitch that fixes the brow from the eyelid incision prevented that drop, and an endoscopic implant lift raised the brow (Baker 2016).
In the lower lid, removing fat from inside the lid fixed the bulges but left wrinkles worse in some patients; adding CO2 laser improved them (Carter 2001). With routine support of the outer corner of the eye when the lower lid is opened through the skin, lid position still needed surgical correction in about 1 in 30 (Codner 2008). An endoscopic midface lift shortened the lower lid and allowed more skin removal than eyelid surgery alone (Marotta 2008). In patients whose cheek sits behind the eye, a midface lift with fat grafting gave higher satisfaction and fewer later procedures than a lift alone (Barone 2021).
Where surgeons disagree
- Brow fixation through the eyelid. In a randomized trial, an internal stitch raised the outer brow while a small temporal lift did not (Zandi 2018). Over five years, the brow came down after the stitch and stayed up after an endoscopic lift (Iblher 2012).
- Open or endoscopic. Critics of endoscopic lifts point to their wider range of complications (Byun 2013) and to hairline recession (Guyuron 2014). Supporters point to less early scalp numbness (Guillot 2011) and equal lift at six years (Aslan Gülbitti 2022).
- Toxin or surgery. Plastic surgeons now use neuromodulator injections far more than two decades ago, and almost a third say injections have replaced some brow lifts (Coombs 2023).
What is new
- In one oculofacial surgeon's records, sex was the main factor in choosing a technique: women most often had endoscopic lifts and men a direct lift above the brow (Feist 2025).
- A hemostatic net, stitched over the skin to close the space under it, was linked to very low rates of bleeding after facelift, brow lift and neck lift; it left red marks in about 1 in 8 that cleared within three months (Ribeiro 2026).
What is still unknown
- Which brow lift is best. No randomized trial compares open and endoscopic lifts (Graham 2011), and complication rates come from case series (Byun 2013).
- Which fixation lasts longest. Long-term measured data on fixation methods remain thin (Şibar 2025).
Key papers
- Carter 2001: lower lid fat removal plus laser treated both bulges and wrinkles.
- Codner 2008: ten years of lower lid surgery with routine outer corner support.
- Graham 2011: found no evidence that open brow lifts do worse than endoscopic lifts.
- Byun 2013: set out complication rates by brow lift technique.
- Baker 2016: showed that eyelid surgery alone lowers the brow and an internal stitch prevents it.
- Aslan Gülbitti 2022: open and endoscopic lifts both held the brow for years.
- Wormer 2023: adding a brow lift to eyelid surgery did not raise major complications.
- Karanfilian 2026: pooled long-term brow lift results by method.