Brow Lift in Valencia: What It Really Raises

In short

🔑 A brow lift raises millimetres, not centimetres. The largest meta-analysis, covering 2,127 brows, gives a sustained elevation of 3.8 mm at the tail, 3.02 mm at the centre and 2.41 mm at the head of the brow.
The brow does not rise as a block: it rotates. The tail rises more than the head, in every study and with every technique. It is what produces a rested look rather than a startled one.
Three millimetres sound like nothing and they show. In a follow-up at 5.4 years, independent observers rated the change as small but noticeable, and 64% of patients were still judged better than before their operation.
⚠️ What does improve lastingly are the frown lines, when the muscles that produce them are treated. The horizontal lines across the forehead improve only temporarily and return to where they started. It is the most honest fact on this page.
There is no single superior technique: there are six families, each with its own complication profile, and they are chosen according to where the brow sits, where the hairline sits and how much forehead there is.
A brow lift is not a hairline lowering. One raises the upper third; the other shortens the forehead by bringing the hairline down. They are constantly confused.
⚠️ The literature on brows is rich in case series and poor in comparisons: the two systematic reviews available both point out the lack of prospective randomised studies.

The brow is the part of the face that most changes the expression and the one people look at least. When it drops, the eyes look tired or stern without anything else having changed, and the forehead starts working all day to compensate.

This page explains the operation that repositions it: how much it really rises — the answer is measured in millimetres and it is surprising —, what techniques exist and what improves and what does not on the forehead.

If you do not yet know whether your problem is the brow, the eyelid or the muscle that lifts it, start with the drooping eyelids page: that is where the examination that separates them is set out. This page assumes you already know that what has dropped is the brow.

What happens to a brow over the years

The brow descends, and it does so unevenly: the tail drops more than the head. That lateral descent is what pushes the skin of the eyelid downwards and creates the sense of a heavy gaze.

The less obvious consequence is that the forehead starts working. The frontalis is the only muscle that lifts the brow, and when the brow needs help, that muscle contracts permanently to hold it up. Two things follow at once: marked horizontal lines and, in many cases, a feeling of tightness or tiredness across the forehead by the end of the day.

🔑 That is why a dropped brow is not only a matter of appearance: whoever has one is making a continuous muscular effort they are not always aware of.

How much it really raises: the millimetres

This is the main contribution of this page, because nobody publishes this figure.

The largest meta-analysis available brought together 22 studies and 2,127 brows, with a weighted mean follow-up of almost 21 months. The sustained elevations were:

Part of the brow	Elevation
Tail (lateral)	3.8 mm
Centre	3.02 mm
Head (medial)	2.41 mm

A second meta-analysis, focused only on the endoscopic technique and its long-term stability, screened more than 5,300 papers to keep 12, and obtained figures of the same order and with the same gradient: 4.35 mm at the tail, 3.86 mm at the centre and 3.25 mm at the head.

Two conclusions worth reading slowly:

🔑 The brow rotates, it does not translate. The tail rises around 50% more than the head. That is exactly what is wanted: raising the head of the brow as much as the tail would produce that permanently startled expression everyone recognises as “done”.
Three or four millimetres look like little in writing and are not little to look at. In a study of 31 patients followed for 5.4 years, objective elevation was under 5 mm, and even so assessors using validated scales described it as small but clearly noticeable, and maintained at five years.

What improves and what does not

This is the section that sets this page apart, and it comes from that same 5.4-year follow-up after subperiosteal endoscopic lift:

✅ The position of the brow is maintained at 5.4 years in every part except the tail, which is where there is some relapse. Consistent with the tail also being where it rose most.
✅ The frown lines improve to a statistically significant degree and that improvement is maintained at 5.4 years, when the depressor muscles that produce them are treated during the operation.
❌ The horizontal lines across the forehead improve only temporarily and return to baseline at 5.4 years.
✅ 64% of patients were still judged “better than before” at 5.4 years.

⚠️ That red point matters and almost nobody says it: if what bothers you most are the horizontal lines across your forehead, a brow lift is not the lasting answer. It makes sense if what bothers you is the position of the brow, the heavy gaze or the frown lines.

The six families of technique

These are not alternatives for the patient to choose between: they are indicated according to where the brow sits, where the hairline sits, how much forehead there is and what else needs correcting.

1. Endoscopic lift. Through small incisions within the scalp, without opening the forehead and with no visible scar. It is the most widespread, and here it is performed in a variant without a camera, through a subcutaneous tunnel and with only two incisions, which allows less undermining. It has its own page: the endoscopic brow lift.

2. Temporal or lateral lift. A short incision at the temple that acts on the tail of the brow. The smallest procedure on the upper third and the one most people ask for: the temporal lift.

3. Coronal lift. An incision crossing the scalp from ear to ear, behind the hairline. It is the classic technique, the one with the most lifting power and the one that moves the hairline furthest back.

4. Hairline (pretrichial) lift. The incision runs right at the hairline instead of behind it. It does not move the hairline backwards — in fact it can shorten a high forehead — at the cost of a scar in a more exposed place.

5. Direct lift. The incision runs just above the brow itself. It is the most precise approach and the one with the most visible scar; it is reserved for particular situations.

6. Transpalpebral approach. Through the same incision as an upper blepharoplasty, the brow is addressed without adding any scars. Its lifting capacity is limited.

🔑 All six are performed at ICPM. None is ruled out in advance: the one that fits each case is recommended and the advantages and drawbacks of each are explained in consultation, so the decision is taken with the patient and not for them. A team’s command of all six is precisely what makes choosing possible; anyone who does only one has to recommend it every time.

The criterion that weighs most is the combination of age and the state of the forehead:

In younger patients, with the forehead still smooth, the usual recommendation is the endoscopic lift: it leaves no visible scar and there is no line in which to hide one.
In older patients, with the forehead already lined, the direct lift gains ground. It sounds counterintuitive — it is the one with the most exposed scar — and it has its logic: there is a crease in which to conceal the incision, it is the most precise approach for the position of the brow, and it is also the least aggressive for anyone with other reasons to avoid major surgery.

The rest — temporal, coronal, pretrichial and transpalpebral — have their own indications, depending on where the brow sits, where the hairline sits and what else needs correcting in the same procedure.

And one technical detail that does make a difference

The meta-analysis of 2,127 brows compared how the brow is fixed in its new position and found two things:

There were no significant differences in long-term elevation or in complications between the pretrichial approach and the one behind the hairline.
Fixation with barbed implants achieved more lateral elevation than fixation with sutures, and also more dysaesthesia — abnormal sensations in the scalp.

It is exactly the kind of trade-off worth knowing about: a little more result in exchange for more discomfort.

🔑 Here fixation is done with sutures, and in the endoscopic lift with a bone tunnel and suture: a small tunnel is made in the cortex of the frontal bone and the stitch that holds the brow is anchored to it. It is an anchorage to bone, which is the only point that does not give.

It is the quiet side of that trade-off, and it is chosen deliberately. In an operation whose goal is three or four millimetres, and whose most frequent complaint afterwards is sensory, exchanging a little lateral elevation for a scalp that bothers you less is a trade that pays.

Who is a candidate

A dropped brow, confirmed with the forehead relaxed. The manoeuvre that tests for it is described in the drooping eyelids page.
A heavy gaze from the weight of the brow, not just from excess eyelid skin.
A forehead that works continuously to hold the brows up.
Marked frown lines that you want treated lastingly.

⚠️ And who is not, or not only:

Anyone with excess eyelid skin and a well-placed brow: that is a blepharoplasty, and it is covered in the blepharoplasty page.
Anyone with true eyelid ptosis, a problem of the muscle that lifts the eyelid, which is a different operation.
Anyone whose main aim is getting rid of the horizontal lines on the forehead, for the reason explained above.
Anyone with a very high forehead who wants it shortened: that is a hairline lowering, which does the opposite of a forehead lift.

Very often they are combined. A brow lift and an upper blepharoplasty are planned together in the same procedure when both are contributing, which is the usual situation.

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Frequently asked questions

Which technique will you use on me?

Whichever fits your case, among the six, and decided with you: at the consultation the advantages and drawbacks of each are explained. As a guide, in younger patients with a smooth forehead the usual choice is the endoscopic lift, and in older patients with a forehead already lined the direct lift gains ground, using an existing crease to hide the incision.

What anaesthetic is used?

It depends on the technique. The endoscopic lift is done under general anaesthetic. The direct brow lift is done under local anaesthetic, with or without sedation, according to what each patient prefers and what the case calls for.

How is the brow held in its new position?

With sutures, and in the endoscopic lift by means of a tunnel made in the frontal bone to which the stitch is anchored: an anchorage to bone, which is the only point that does not give. We do not use barbed implants, which achieve somewhat more lateral elevation in exchange for more abnormal sensation in the scalp.

How much does a brow lift raise the brow?

Millimetres. The largest meta-analysis, with 2,127 brows and almost 21 months of mean follow-up, found a sustained elevation of 3.8 mm at the tail, 3.02 mm at the centre and 2.41 mm at the head of the brow. It sounds like little and it is visible: in a follow-up at 5.4 years, independent assessors described the change as small but noticeable.

Will I end up looking startled?

That is what the operation is designed to avoid, and its geometry helps: the brow rotates more than it translates, with the tail rising around 50% more than the head. A uniform elevation of the whole brow would indeed produce that expression.

Will it get rid of my forehead lines?

Only temporarily. In the 5.4-year follow-up, the horizontal lines across the forehead improved at first and returned to where they started. The frown lines, by contrast, improved significantly and that improvement held, when the muscles that produce them were treated.

How long does the result last?

The position of the brow held at 5.4 years in every part except the tail, where there is some relapse. At those five years, 64% of patients were still judged better than before their operation.

Which technique is best?

There is no superior one. The two systematic reviews available describe different complication profiles for each technique and both point out the lack of prospective randomised studies comparing them. The choice depends on where the brow sits, where the hairline sits and what else needs correcting.

Is it the same as a hairline lowering?

No, and they are almost opposites. A forehead or brow lift raises the upper third without moving the hairline — the coronal version actually moves it backwards. A hairline lowering brings the hairline down to shorten a high forehead.

Can it be done at the same time as a blepharoplasty?

Yes, and it is common, because in many cases both are contributing. Blepharoplasty is in fact the procedure most often added to facial surgery.

Sources

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 with a weighted mean follow-up of 20.9 months: significant elevation of 3.8 mm at the lateral brow, 3.02 mm at the central and 2.41 mm at the medial; no significant differences in elevation or in complications between pretrichial and post-trichial approaches; fixation with barbed implants achieved greater lateral elevation and higher rates of dysaesthesia than fixation with sutures.
Şibar S, Dikmen AU, Erdal AI. Long-term Stability in Endoscopic Brow Lift: A Systematic Review and Meta-Analysis of the Literature. Aesthetic Surgery Journal, 2025. PMID 39542644. — 5,324 papers screened, 85 full texts reviewed and 12 studies included: pooled long-term elevation effects of 3.25 mm at the medial brow, 3.86 mm at the central and 4.35 mm at the lateral.
Jones BM, Lo SJ. The impact of endoscopic brow lift on eyebrow morphology, aesthetics, and longevity: objective and subjective measurements over a 5-year period. Plastic and Reconstructive Surgery, 2013. PMID 23897351. — 31 patients with 5.4 years of follow-up after subperiosteal endoscopic lift: objective elevation of under 5 mm that persisted in every part except the tail of the brow; a small but noticeable change for observers, maintained at 5.4 years; resection of the depressor muscles produced a significant reduction in frown lines that was maintained at 5.4 years; the improvement in horizontal forehead lines was temporary and relapsed to baseline; 64% of patients were still judged better than before surgery.
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. — Review of 76 studies: the highest revision rate in the hairline lift (7.4%), of numbness in the direct lift (5.5%), of asymmetry in the temporal or lateral lift (1.5%) and of alopecia in the endoscopic lift (2.8%); each technique has a different complication profile; the authors highlight the lack of prospective randomised studies and of standardised outcome measures.
Byun S, et al. Complications of browlift techniques: a systematic review. Aesthetic Surgery Journal, 2013. PMID 23388642. — 82 studies with weighted proportions by technique; the authors conclude that a well-designed comparative study is needed to establish the real complication rate across the different techniques.

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If your gaze looks heavy and you do not know whether the problem is in the eyelid or higher up, the examination settles it in a minute: the position of the brow is assessed with the forehead relaxed and it becomes clear what is contributing and in what proportion. At our practice in Valencia we explain what can be raised, by how many millimetres, and what is not going to change.