Brow-line incision: Where to have it done? Choose based on whether they assess eyebrow height and eyelid opening

A brow-line incision should be performed at a clinic that assesses not only upper-eyelid sagging but also eyebrow height and eyelid opening, and compares it with other methods[1][2]. A brow-line incision does not lift the eyebrow itself, and in people with lowered eyebrows, one method alone may be insufficient.[1].

What kind of sagging (skin laxity) can a brow-line incision correct?

A brow-line incision is suited for sagging where excess upper-eyelid skin drapes downward. Because the skin is excised along the lower border of the eyebrow, the scar tends to be hidden by the eyebrow, and the original double-eyelid line is often preserved.[3].

It is frequently chosen by people who do not want to significantly alter their appearance.[3]. In a study of 64 patients, 93.88% of the 49 whose follow-up was complete were satisfied, with no postoperative complications.[1]. However, this was a single-center study by one surgeon, and the follow-up period averaged 7.5 months.[1].

If the eyebrow itself is lowered, should I also compare it with other methods?

If the eyebrow itself is lowered, ask to compare it with brow-lift surgery as well. The Japanese Society of Plastic Surgeons' guidelines recommend performing brow-lift surgery and upper-eyelid surgery for eyebrow ptosis and accompanying eyelid ptosis.[4].

It is noted that in people with lowered eyebrows or naturally low eyebrows, a brow-line incision alone may be insufficient.[1]. The most common complaint after brow-lift surgery was "sagging of the eyelid remained," with inadequate skin removal cited as the cause.[5].

Will they assess eyelid opening (ptosis)?

Whether there is ptosis—weakness in the ability to open the eyelid—is another point you should have evaluated beforehand. The American Society of Plastic Surgeons' guidelines recommend correcting both conditions simultaneously in people with both sagging and ptosis.[2].

However, combining a brow-line incision with ptosis surgery carries the concern that removing more skin may make it difficult to close the eye.[3]Removing too much skin can cause dry eyes because the eyelid does not close completely.[6]. Ask specifically how much skin will be removed.

How is the scar and change in eyebrow shape prevented?

With a brow-line incision, the eyebrow height may lower slightly.[1]. Pulling the scar tightly during suturing can cause the eyebrow to lower over time.[1].

Unnatural wrinkles on the eyelid are also a recognized concern, and there are reports that results remained stable at 6 and 12 months with techniques to suspend muscle.[7]. There are also reports that in people over 60 years old, results were stable over the long term when thick skin below the eyebrow was also removed.[8].

Where should I have it done? Guidelines when uncertain

During consultation, ask about the following points.

Assessment: Do they distinguish whether sagging is from excess skin or eyebrow ptosis?[1][4]

Comparison: Do they compare it with brow-lift surgery and surgery from the double-eyelid line?[4][2]

Eyelid opening: Do they explain whether ptosis is present and whether it will be corrected simultaneously?[3][2]

Outcome: Do they discuss changes in eyebrow height and scar visibility?[1][7]

Whether a brow-line incision is right for your sagging cannot be determined from an article alone. At your consultation, tell the doctor your eyebrow position and eyelid opening, whether you want to preserve your double-eyelid line, and discuss the differences between methods with your physician.