In short
- 🔑 There is no technique without complications: there are techniques with different profiles. The two available systematic reviews, of 82 and 76 studies, agree on that and disagree on which comes off worst.
- The most frequent problems are sensory: numbness of the scalp behind the incision, which reaches 6.2% persistently in endoscopic techniques and 5.4% in hairline techniques.
- Hair loss around the scar is 3.0% with the endoscopic approach and 8.5% with the anterior hairline incision and subcutaneous dissection, which is the highest rate of the whole set.
- ⚠️ Lagophthalmos — not being able to close the eye fully — appears in 2.7% of subperiosteal endoscopic techniques. It is usually temporary and it is the complication that calls for real vigilance, because an eye that does not close is an unprotected eye.
- Asymmetry between the two sides runs from 1.5% with the temporal technique to 3.6% with the endoscopic one.
- The most frequent reoperation is with the hairline technique: 7.4%.
- Haematoma and infection are rare in this surgery: 0.5% and 0.2% with the coronal approach.
- ⚠️ And the methodological warning the authors themselves give: these are weighted proportions from case series, not from comparative studies. Prospective randomised trials are lacking.
Surgery of the upper third has one particularity: its most frequent complications are not the serious ones, they are the irritating ones. A numb scalp for months, a bald strip beside the scar, one side slightly higher than the other.
This page gives the real rates, technique by technique, which is how they are published and how nobody presents them. And it explains what to expect in recovery.
The rates, technique by technique
The two available systematic reviews group things differently, so it is worth seeing both.
Review of 82 studies, by incision and dissection plane
| Technique | Complications |
|---|---|
| Endoscopic, subperiosteal dissection | Paraesthesia 6.2% · Asymmetry 3.6% · Alopecia 3.0% · Lagophthalmos 2.7% |
| Coronal, subgaleal dissection | Unacceptable scar 3.6% · Haematoma 0.5% · Infection 0.2% |
| Anterior hairline, subcutaneous dissection | Alopecia 8.5% · Paraesthesia 5.4% · Unacceptable scar 2.1% · Skin necrosis 1.8% |
The authors’ conclusion: unacceptable scarring and paraesthesia are the most common complications across brow lifts as a whole, and endoscopic techniques are associated with a wider variety of complications than open approaches.
Review of 76 studies, by “which is worst at what”
| Complication | Technique with the highest rate | Rate |
|---|---|---|
| Reoperation | Hairline brow lift | 7.4% |
| Numbness | Direct brow lift | 5.5% |
| Alopecia | Endoscopic brow lift | 2.8% |
| Asymmetry | Temporal or lateral brow lift | 1.5% |
🔑 Read them together and the important thing appears: there is no clean column. Each technique wins on one thing and loses on another. Choosing means accepting a profile, not avoiding the risk.
What each of these complications is
The numb scalp
It is the most frequent and the least warned about. Lifting the forehead interrupts sensory branches, and the area behind the incision — towards the crown — is left numb. You notice it when combing your hair, washing it, resting your head.
It recovers gradually over months, and during that process it is usual to feel itching, tingling or small electric shocks: that is reinnervation, not a problem.
⚠️ Persistent in 5-6% depending on the technique. And there is an added factor: in the meta-analysis of 2,127 brows, fixation with barbed implants had significantly higher rates of dysaesthesia than fixation with sutures, in exchange for more lateral elevation.
The bald strip
The incision crosses scalp. Tension and handling of the follicle can produce a band of hair loss along the scar, usually temporary — the follicle goes into rest and comes back.
It can be permanent if there was too much tension or direct follicular damage. It is the complication most specific to this surgery in terms of aesthetic impact, and its rate varies a great deal with technique: from 3% with the endoscopic approach to 8.5% with the anterior incision and subcutaneous dissection.
The eye that does not close fully
Lagophthalmos is the inability to close the eyelid completely. In the context of brow surgery it usually appears when the brow is raised more than the upper eyelid can follow, and it is usually temporary.
🚨 It is the complication of this surgery that calls for real vigilance, because an eye that does not close is an eye that does not lubricate: the cornea is left exposed. If it appears, tell your surgeon — do not wait for the review — and follow their instructions on eye protection.
Its rate was 2.7% in subperiosteal endoscopic techniques.
The brow that ends up high, or different
Two different things:
- Asymmetry between the two sides: from 1.5% to 3.6% depending on the technique. Part of it is because the brows were already asymmetric to start with — almost all are — and it becomes more obvious once they are raised.
- Overcorrection, the permanently surprised expression. It is what is avoided by raising the tail more than the head of the brow, which is how brows rise in the published series.
When something like this means operating again, the highest reoperation rate — 7.4% — belongs to the hairline technique.
The brow that does not rise
If the frontal branch of the facial nerve is affected, that eyebrow does not rise and that side of the forehead does not wrinkle. It is the same branch that is exposed in a facelift.
In a series of 250 patients operated on through an extended temporal approach, it appeared unilaterally in 5.6% and resolved spontaneously at a mean of 2.8 months.
Haematoma, infection and scarring
- Haematoma: 0.5% and infection: 0.2% with the coronal approach. They are low figures compared with the facelift, where haematoma is the main complication.
- Unacceptable scarring: 3.6% with the coronal approach and 2.1% with the anterior incision. Along with paraesthesia, it is the most common complication of the whole set.
- Skin necrosis: 1.8% with the anterior incision and subcutaneous dissection, which is the approach that most compromises the blood supply of the forehead skin.
What recovery is like
⚠️ A warning first: recovery from this surgery is far less well documented than its complications. What follows describes the process; the specific timings are set by the surgeon.
The first few days. Swelling of the forehead which, with gravity, descends towards the eyelids and sometimes towards the cheeks. It is why many patients take fright on the second day at the sight of swollen eyes when no eyelid surgery has been done. There may be bruising in the same area.
A feeling of tightness in the forehead and that the brows “are high”: partly it is real — they are — and partly it is swelling, which goes down.
The removal of stitches or clips, depending on the material used.
The following weeks. The swelling eases and the scalp is still numb. Here the long phase begins: sensation takes months to come back, with episodes of itching and tingling.
The following months. The definitive position of the brow becomes apparent once all the swelling has gone. Assessing the height of a brow at two weeks is assessing swelling.
The timings used here, common to the clinic’s facial surgery:
| Washing your hair | From the first review onwards, at around the 3rd or 4th day |
| Colouring your hair | At one month |
| Gentle exercise | At two weeks |
| Intense exercise | At one month |
| Driving | Fit from the 2nd day; the recommendation is to wait a week |
🔑 The two figures for driving do not contradict each other. One says when you are fit and the other when it is advisable: with swelling in the forehead and the eyelids, your visual field and your reflexes are not where they were.
⚠️ And the limit in the first few weeks is not tiredness: it is blood pressure, which is what makes a recently undermined area bleed.
What is done to these scars: almost nothing, and that is the answer.
There is no particular care protocol for a scalp scar, beyond sun protection for a year, which is what the clinic’s scar protocol specifies for any recent scar.
🔑 Nor does covering it with make-up usually come up, for the same reason it needs nothing else: it stays hidden inside the hair. It is the biggest practical difference between this surgery and a facelift, where the scar runs around the ear and make-up really is a date you wait for.
Fixation is done with sutures, and in the endoscopic brow lift by means of a tunnel made in the frontal bone to which the stitch is anchored: an anchor to bone, which is the only one that does not give. Barbed implants are not used, and it is a choice that has everything to do with this page: they achieve a little more lateral elevation, but also more scalp dysaesthesia, which is among the discomforts that linger longest after surgery.
Scalp stitches are removed at around day 10. That is a little later than on the face — where they come out at seven days — because it is an area under more tension and with hair.
⚠️ The date moving by a few days does not mean anything is wrong. The exact day is set by whoever operated, looking at how the wound is doing.
🚨 When to ring without waiting
✅ Before the list, the most reassuring part: who you ring. At this clinic the patient has their surgeon’s direct contact. There is no switchboard in the way and no clinic hours to wait for. And if your surgeon cannot be reached at that moment, the team is six plastic surgeons and there is always someone available to deal with an emergency.
- 🚨 If the eye does not close fully, above all if you also feel grittiness, stinging or pain. It is the most important sign in this surgery.
- 🚨 Pain that increases, above all if it is on one side only and with swelling that grows over hours.
- 🚨 Fever, or increasing redness and warmth around an incision.
- 🚨 Active bleeding that does not stop with gentle pressure.
Get in touch without urgency if you notice a brow that does not rise, asymmetry between the two sides, numbness or a bald area beside the scar. They are reasons for follow-up, not for a night-time call, and most resolve on their own.
⚠️ If you had surgery at another clinic, the person who has to see you is the person who operated on you, and outside their hours, hospital A&E. Our clinic is available for anything that is not urgent.
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Frequently asked questions
Which complication is the most frequent in a brow lift?
Sensory ones and scarring. In the review of 82 studies, persistent paraesthesia reached 6.2% in endoscopic techniques and 5.4% in anterior hairline techniques, and unacceptable scarring 3.6% with the coronal approach.
Will I lose hair?
A strip of hair loss can appear along the scar, usually temporary. The rate depends a great deal on the technique: from 3.0% with the endoscopic approach to 8.5% with the hairline incision and subcutaneous dissection.
Is it true that my eye might not close?
It is a described complication, with a rate of 2.7% in subperiosteal endoscopic techniques, and it is usually temporary. It is the one that calls for most vigilance, because an eye that does not close leaves the cornea unprotected: if it happens, tell your surgeon without waiting for the review.
How long does scalp sensation take to come back?
Months, gradually and unevenly, with episodes of itching and tingling that are part of reinnervation. In a proportion of around 5-6% depending on the technique, the numbness persists.
Could one side end up higher than the other?
It is possible: asymmetry runs from 1.5% with the temporal technique to 3.6% with the endoscopic one. It is also worth knowing that almost all brows are asymmetric to begin with, and raising them can make a difference that already existed more obvious.
When is the final result visible?
Once all the swelling has gone, which is what distorts the perception of height. Assessing the position of the brows in the first two weeks is assessing swelling.
Is it riskier than a facelift?
It carries less risk of the serious complications — haematoma is 0.5% and infection 0.2% with the coronal approach, against a haematoma that is the main complication of the facelift — and more of the irritating ones: numbness, hair loss and asymmetry.
Sources
- Byun S, et al. Complications of browlift techniques: a systematic review. Aesthetic Surgery Journal, 2013. PMID 23388642. — 82 studies and proportions weighted by random-effects model: endoscopic technique with subperiosteal dissection — paraesthesia 6.2%, asymmetry 3.6%, alopecia 3.0%, lagophthalmos 2.7%; coronal incision with subgaleal dissection — unacceptable scarring 3.6%, haematoma 0.5%, infection 0.2%; anterior hairline with subcutaneous dissection — alopecia 8.5%, paraesthesia 5.4%, unacceptable scarring 2.1%, skin necrosis 1.8%; unacceptable scarring and paraesthesia are the most common complications of the whole set; the authors warn of the limitations inherent in case series and of the need for a well-designed comparative study.
- Cho MJ, Carboy JA, Rohrich RJ. Complications in Brow Lifts: A Systemic Review of Surgical and Nonsurgical Brow Rejuvenations. Plastic and Reconstructive Surgery – Global Open, 2018. PMID 30534495. — 76 studies: the highest revision rate with the hairline brow lift (7.4%), numbness with the direct brow lift (5.5%), alopecia with the endoscopic one (2.8%) and asymmetry with the temporal or lateral one (1.5%); each technique has a different complication profile; a lack of prospective randomised studies and of standardised outcome measures.
- Karanfilian T, et al. Long-Term Brow Lift Outcomes: A Systematic Review and Meta-Analysis. Ophthalmic Plastic and Reconstructive Surgery, 2026. PMID 40788666. — 22 studies and 2,127 brows: fixation with barbed implants achieved significantly greater lateral elevation and significantly higher rates of dysaesthesia than fixation with sutures; no significant differences in elevation or complications between pretrichial and posttrichial approaches.
- Şirinoglu H, Ergün Tatar B, Güvercin E. Long Terms Results of Temporal Facelift: 6 Years of Experience in 250 Cases. The Journal of Craniofacial Surgery, 2025. PMID 39641911. — 250 patients: unilateral neurapraxia of the frontal branch of the facial nerve in 5.6%, resolving spontaneously at a mean of 2.8 months; persistent dimpling in 2.8%, resolved by the fifth month; revision in 2.4%; no haematomas, necrosis, infections or seromas.
- Jones BM, Lo SJ. The impact of endoscopic brow lift on eyebrow morphology, aesthetics, and longevity. Plastic and Reconstructive Surgery, 2013. PMID 23897351. — 31 patients with 5.4 years of follow-up: elevation maintained in every zone except the tail of the brow.
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If you are considering brow surgery, the conversation worth having in clinic is what the risk profile is of the technique being proposed to you — not that of the procedure in the abstract. At our clinic in Valencia we explain which approach applies to your case and which complications go with it.
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Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
