A browlift is a common plastic surgery procedure for rejuvenation of the upper third of the face. Gravity and facial expressions work together to create a low downward progression of the eyebrows in some people. This lengthens the forehead skin between the frontal hairline and the eyebrows. (for those patients that still have a frontal hairline!) This Taken together both can give one a tired and aged appearance.
Browlifts can be done in variety of ways which differ primarily in where the incision is made. Most browlift surgeries, however, produce an upward elevation of the eyebrows at the expense of actually lengthening the forehead skin or distance between the eyebrows and the hairline. In many patients, this forehead lengthening is not significant or irrelevant given their preoperative forehead length. However, for those with a long forehead to start, a longer forehead may not be a good aesthetic trade-off for higher brows.
Only one type of browlift can simultaneously lift the eyebrows and shorten the forehead length. (and even bring the frontal hairline down lower if desired) Known medically as the pretrichial browlift, it is better described as a hairline browlift. Rather than make a traditional browlift in the scalp behind the frontal hairline, the incision is made just at or a few millimeters behind the leading edge of the hair. This approach provides not only a shorter distance down to the muscles between the eyebrows but does not change or move back the hairline when the brows are lifted. The extra forehead skin (caused by the amount that the brows are lifted) is then trimmed and closed at the hairline.
For those patients with a long forehead, this is the only good browlift option. Understandably, one would be concerned about the appearance of the scar since it is not be completely in the scalp hair. One of the factors to consider in deciding if this is a good option is to look at one’s hairstyle. For those who wear bangs or have a side sweeping hair pattern or style, then the scar is not an issue. For those who always wear their hair back (and most women who have long foreheads usually do not prefer that hairstyle), then one has to think twice.
The hairline scar, however, really turns out well for most patients. While it is red for a few months after surgery, it fades quite quickly and ends up as a very fine line, white scar. This scar is particularly well hidden in light to medium colored hair and skin. By contrast, it may be more noticeable in dark hair and skin colors.
The power of the hairline browlift lies in its combination browlift and forehead skin reduction. It can be a very effective procedure in the right patient with a  good quality frontal hairline and a long forehead with or without temporal recession. While it is most commonly used for female cosmetic surgery, it is also the browlift of choice in facial feminization surgery.
Dr. Barry Eppley
Indianapolis, Indiana