Brow-lower eyelid lift vs. double-eyelid lift: research on satisfaction rates, who it suits, and precautions

The Brow-lower eyelid lift (a surgery that removes skin below the brow to address sagging of the upper eyelid) showed 93.88% satisfaction in a study following 49 people, with no complications after surgery[1]. However, this was a study from one hospital[1]. In people with brow descent, eyelid surgery alone may not lead to satisfaction[2].

What changes with a brow-lower eyelid lift?

Both brow and eyelid position, as well as feelings about appearance, improved according to reports. In a study where 64 people underwent surgery and 49 people (98 eyes) were followed for an average of 7.5 months, all metrics measuring brow and eyelid position improved[1].

Scores measuring appearance-related social anxiety also decreased[1]. Satisfaction rates were 71.43% very satisfied and 22.45% satisfied, for a combined total of 93.88%[1].

This study was conducted by one physician at one hospital[1]. Some patients were not followed through to the end, so results cannot be directly applied to everyone.

How does it differ from the double-eyelid fold method?

Different incision sites produce different changes. With surgery that cuts along the double-eyelid fold line, the visible width of the eyelid widens, though the brow may descend slightly[3].

Opinion remains divided on the best way to remove lateral canthal sagging[3].

The Brow-lower eyelid lift is described as a good option for middle-aged and older Asian women with moderate to severe sagging, or those who lift the brow using forehead muscles to open the eyes[4]. The method can also be used in men and younger women[4].

What if the brow is significantly descended?

In people with severe brow descent, eyelid surgery alone may be insufficient. It is noted that brow descent makes upper-eyelid sagging more prominent, and eyelid surgery alone often does not lead to satisfaction[2].

It is also noted that if the brow is not corrected before eyelid surgery, further brow descent may occur after the procedure[2]. On the other hand, if upper eyelid skin remains even when the brow is manually elevated, eyelid surgery in combination may be necessary[5].

What about scarring and sensation after surgery?

The naturalness of the result varies depending on the incision shape. It has been noted that the elliptical method of removing skin below the brow has the drawback of creating unnatural wrinkles[6]. For this reason, techniques involving diagonal upward lift of skin and muscle have also been reported[6].

After surgery, a tingling sensation may occur around the brow. This is explained as a sign that sensation is returning[4].

What should you confirm before surgery?

During consultation, ask about the following points:

Brow position: how much upper eyelid skin remains when the brow is lifted[5]

Incision site: below the brow or along the double-eyelid fold[4][3]

Brow descent: whether brow-lifting surgery should also be considered[2]

Scarring: the incision shape and measures to prevent wrinkles[6]

Which surgery suits you best cannot be determined from an article alone. During your examination, have your brow height and amount of eyelid sagging assessed, and confirm the differences in incision sites.