Endoscopic Brow Lift

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Brow Aesthetics Female vs Male

Female eyebrows are 2-3 mm above the supraorbital rim (upper bony prominence of the eyeball socket) and have an arch shape. The apex of the arch is at the junction of the inner 2/3rd and outer 2/3rds of the eyebrow. This is the highest point of the eyebrow. The inner or medial part of the eyebrow located at the inner corner of the eye is the low point. The eyebrow, then gently arches up towards the apex where the outer part of the eyebrow is 2-3 mm higher than the inner part.

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Male Eyebrows on the other hand, are located right on the supraorbital rim. They are less arched and straight. The outer part of the eyebrow is close to the same level as the inner part of the eyebrow. The arching that you see is mild to none.

Anatomy of the Brow

The brow is the front area of the scalp with the following layers;

1. Skin
2. Subcutaneous Tissue or Fat
3. Galea or Frontalis muscle
4. Loose areolar tissue layer
5. Pericranium or Periosteum

From the superior orbital rim to the hairline the brow length is 5 – 6 cm. Anything more than this can be considered a high forehead anything less and short forehead.

The important nerves and vessels that pass through the brow are the supraorbital and supratrochlear nerves, the frontal or temporal branch of the facial nerve, the sentinel vein, and the supratemporal artery and vein.

Eyebrow Muscles

The Frontalis muscle is responsible for brow elevation and creates “worry lines”, the horizontal creases, one sees when they elevate the brow. Botox is commonly used to temporarily treat these lines. Depressors of the brow include the Procerus muscle, corrugator muscles, and the orbicularis oculi muscle. These muscles create the 11’s lines when contracted.

The depressor muscles are important in brow lift because they act as the “brakes” or opposing force for trying to raise the brow up. These muscles can be removed during surgery either partially or almost completely to resist these opposing forces.

Ligaments or Fusion Points

These are strong adherence areas of the brow to the underlying facial skeleton. They fix the brow in position and must be released during surgery to allow mobilization of the brow so that it can be moved upwards.

1. Arcus Marginalis at the Superior Orbital Rim
2. Superior Temporal Fusion Line
3. Lateral Orbital Retaining Ligament

Brow Droop or Ptosis

The brow drops with the weakening of the ligaments and soft tissues. Some patients have low eyebrows genetically. Drooping of the brow will affect the overall appearance of the upper face and eyes. The severity of bow descent and baseline anatomy will determine what procedure will be most effective.

Types of Procedure Performed

1. Open Brow Lift: The incision is in three main areas;
   • Coronal: 5-6 cm behind the hairline from one side to the other
   • Pretrichial or Hairline: Along the hairline
   • Direct Brow: Upper part of the eyebrow
2. Endoscopic Brow Lift (Minimally Invasive): Small incisions behind the hairline which are well hidden in the hair-bearing area.
3. Minibrow Lift: Various incisions in front of the hairline or behind the hairline that are smaller. This may be limited to the temporal brow for a lateral or outer eyebrow lift.

Endoscopic Technique

This is minimally invasive with small incisions behind the hairline. In general, no skin is removed and the lift is created by the suspension of the underlying tissues. It is important to go to a Plastic Surgeon who is familiar with this technique. The downtime is less than the open technique and healing is quicker.

How Much Does Brow Lift Cost?

The cost of a Brow Lift varies depending on the work your operation requires. Prescribed post-operative medications, anesthesia, and hospital fees can also affect the overall cost.

A Brow Lift procedure is purely aesthetic in nature, and because of this, medical insurance will not cover it. We offer financing options like Alphaeon Credit, CareCredit, and PatientFi to make procedures like mini facelifts convenient and accessible for patients.

Age Related Changes of the Eyebrow

Aging affects the eyebrows in gradual and predictable ways, though the rate and pattern of change can vary significantly across different ethnic groups. Over time, several key transformations occur:

1. Gradual Descent of the Eyebrow

• The lateral (outer) brow tends to droop more noticeably than the inner portion. This contributes to lateral hooding.
  • Studies show it may drop by 2–3 mm every 20 years, leading to heaviness over the outer eyelids.

2. Flattening of the Brow Arch

• The apex (highest point) of the brow becomes less pronounced with age.
• This reduces the youthful arch and contributes to a flatter brow shape.

3. Shift of the Brow Apex

• The brow peak gradually shifts further laterally (outward) over time.
  • This contributes to female eye brow looking more masculine with age

4. Brow Thinning

• With age, hair density decreases, leading to a thinner brow appearance.
  • This can be more apparent with menopause. The decline of estrogen can reduce hair density and caliber

What is a youthful brow contour?

The eyebrows play a key role in facial expression, character, and balance. Their shape and position can vary based on gender, ethnicity, age, and even fashion trends. Understanding these differences is important in both makeup design and cosmetic surgery.

Female Eyebrows (Figure 1a)

Shape

• Typically show a gentle arch.
• The apex (highest point) of the arch usually peaks at or just lateral to the lateral limbus (the outer edge of the iris).
• The medial brow “head” aligns with the nasal ala (side of the nostril) when traced vertically upward.
• The tail of the brow aligns on a diagonal line from the base of the nostril through the lateral canthus (outer corner of the eye).

Position

• Generally sit a few millimeters above the supraorbital rim (the bony ridge above the eye socket).
• The lateral tail is often the same height as, or slightly higher than, the medial brow head.

Male Eyebrows (Figure 1b)
Shape

• Usually straighter and flatter than female brows.
• Tend to be thicker, heavier, and less arched.
  • The arch, when present, is usually located more lateral than in female brows.

Position

• Typically sit at or just above the supraorbital rim, about 2.5 mm lower than female eyebrows on average.
  • This lower placement gives the brow a heavier, stronger, and more masculine appearance.

Ethnic differences in women’s eyebrows: 

The shape, position and density of eyebrows can vary significantly across ethnic groups. These differences influence brow shape, position, and cosmetic preferences.

East Asian Women (Chinese, Japanese, Korean)

• Shape: Brows are typically straighter and less arched compared to Western norms.
  Position: Sit closer to the orbital rim
• Hair density: Usually moderately dense, with smooth, dark brow hairs

 African Descent (Wide variation)

• Shape: Eyebrows tend to be flatter and less arched.
• Position:  Sit closer to the orbital rim
• Hair density: Brows may appear shorter in length, with less overall hair density

Schedule a Consultation

Schedule your consultation for Brow Lift in Bellevue– contact Dr. Parikh and set up your appointment. During your appointment, you will be able to ask questions and bring up any concerns you may have about the procedure. Contact us today to get the look you’ve always wanted!

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