What the research shows
Browpexy. Removing upper eyelid skin on its own can pull the brow down a little (Baker 2016, Menderes 2024), and securing the brow through the same incision prevents that drop (Georgescu 2010). McCord described stitching the brow higher through the eyelid crease (McCord 1990), and Zarem fixed the outer part of the muscle around the eye so the brow could not drop below the bony rim (Zarem 1997). The result is a steadier brow and a lift of a few millimetres at the tail; an endoscopic lift raises it further (Baker 2016). In randomized trials in women, the stitch added fullness to the outer brow and lid (Figueiredo 2024), raised the outer brow where a temporal brow lift did not (Zandi 2018), and matched a nylon thread suspension with less scarring (Sugino 2022). It suits mild to moderate droop of the outer brow; heavy brows, marked droop, more droop on the inner side and facial palsy may need a different lift (Nemet 2019).
The direct brow lift. An ellipse of skin comes out within or just above the brow hairs; the cut can also sit in the midforehead or the eyelid crease, or treat only the outer brow (Perry 2022). It gives a predictable result and high satisfaction (Booth 2004), and at one year the head and tail of the brow held with only a slight fall while patients rated the scar better over time (Marangi 2026). It works well in balding men and people with a high hairline, where the scar hides in the brow (Pascali 2016). The midforehead version scored well with masked raters (Powell 2011) and suits balding men with a deeply lined forehead (Huijing 2010).
Scar and numbness. Forehead numbness is the common side effect, reported in up to about 4 in 10 brow lifts (Barker 2013), and most patients tolerate it well (Booth 2004). A shallow angled cut that lets brow hair grow through the scar, limited undermining, anchoring the brow to the bone lining and a layered closure left the scar hard to see in more than 8 in 10 cases (Khan 2026). In facial palsy patients, a zigzag incision with angled edges and bone anchoring caused no numbness or brow hair loss (Butler 2021). After surgery, silicone gel did not improve the scar (Cadet 2018); laser sessions pleased patients, but masked observers could not see the difference (Tenzel 2016).
Where surgeons disagree
- Internal or external browpexy. The stitch through the eyelid and the stitch through a small brow cut gave a similar lift at a few months and at two years (Mokhtarzadeh 2017, Kaderli 2020); one study found the external stitch lifted more at three months (Huang 2023).
- Whether eyelid surgery alone lowers the brow. Some found a small drop (Baker 2016, Huang 2023), one found a rise (Mokhtarzadeh 2017) and one found no change (Kaderli 2020).
- How long browpexy holds. Most patients in one series kept the outer brow at or above its starting height for years (Niechajev 2004). Another found it sank over up to five years while endoscopic lifts held (Iblher 2012), and a third found three brow procedures all sat slightly lower at one year (Beck 2023).
- Who should have a direct brow lift. One unit keeps it for middle age and beyond because the scar shows more in younger skin (Booth 2004); others use it in women and for cosmetic lifts when the scar steps are followed (Pascali 2016, Khan 2026).
What is new
- A deep plane direct brow lift divides and lifts the ring muscle of the eye at the brow and suspends the brow fat; nearly all patients had even brows, and numbness passed within 3 to 5 months (Fakih-Gomez 2025).
- Lifting the fat pad behind the brow muscle during a direct brow lift relieved heaviness and outer hooding in men, with no revisions (Murdock 2026).
What is still unknown
- How long each method holds: follow-up is often a few months, and brow height is measured on flat photographs (Huang 2023, Mokhtarzadeh 2017).
- Whether results carry across patients: the browpexy trials are small and enrolled women, while many direct brow lift series studied men (Zandi 2018, Pascali 2016).
- Which scar care after surgery helps (Cadet 2018, Tenzel 2016).
Key papers
- McCord 1990: described browpexy through the eyelid crease.
- Booth 2004: the direct brow lift gave predictable results and high satisfaction.
- Georgescu 2010: compared five brow techniques; lifting through the eyelid incision prevents the drop.
- Baker 2016: a measured browpexy stitch stopped the drop that eyelid surgery alone caused.
- Zandi 2018: in a randomized trial, browpexy raised the outer brow and a temporal lift did not.
- Khan 2026: set out the steps that keep a direct brow lift scar hard to see.
- Fakih-Gomez 2025: introduced the deep plane direct brow lift.