Eyebrow-level incision: How much upper-eyelid sagging can be removed? The distinction between double-eyelid incision and brow surgery

Eyebrow-level incision is a procedure that removes excess skin on the upper eyelid just below the eyebrow, reducing upper-eyelid sagging (skin laxity).[1]It is not a surgery that lifts the eyebrow itself significantly; rather, the goal is to reduce the skin that drapes over the eyelid.[1]The answer differs depending on whether the eyebrow is drooping or whether you want to create double eyelids, and whether another surgery should be combined.[1][2].

What changes with eyebrow-level incision?

Eyebrow-level incision removes skin and subcutaneous tissue along the margin below the eyebrow, reducing the skin that drapes over the upper eyelid.[1]In a study from China following 49 people for an average of 7.5 months, all indices measuring the position of the eyebrow and eye area showed improvement.[1].

Anxiety scores regarding appearance also decreased, with 93.88% reporting satisfaction.[1]However, this study from a single facility by one physician, and the follow-up period has not reached one year, so these results should be interpreted with caution.[1].

How does it differ from the double-eyelid line incision method?

The skin of the upper eyelid is thinner closer to the lashes and becomes thicker as it approaches the eyebrow.[3]When skin is cut along the double-eyelid line, this change in thickness can be disrupted, and skin may appear to drape over the line.[3].

The double-eyelid line incision method may require longer recovery time because it involves intervention in the eyelid structure.[3]For this reason, the method of removing skin below the eyebrow is also widely used for sagging in Asian eyelids.[3].

Who is it suitable for?

According to Korean reports, it becomes a good option for middle-aged and older women with moderate or greater eyelid sagging (skin laxity), and for people who lift their eyebrows using forehead muscles to open their eyes.[4]The method can also be used in men and younger women.[4].

As age increases, sagging tends to be more pronounced toward the outer corner of the eye.[2]It has been noted that removing skin only along the middle of the eyelid with a double-eyelid incision alone may make the outer corner appear loose.[2].

Is eyebrow-level incision alone enough for someone whose eyebrow has dropped?

For people whose eyebrow itself has descended or who naturally have a low eyebrow, eyebrow-level incision alone may be insufficient.[1]Eyebrow-level incision is a procedure to remove excess skin, not to raise the eyebrow position significantly.[1].

Eyebrow descent makes upper-eyelid sagging more noticeable and can be a reason why eyelid surgery alone does not satisfy patients.[5]The Japanese Society of Plastic Surgeons' guideline proposes performing both a brow-lift procedure and eyelid surgery for eyebrow descent and associated eyelid descent.[6]This improves both visual function and appearance.[6].

Additionally, if the closure is pulled too tightly during suturing, the eyebrow can paradoxically descend.[1].

What happens to scars and post-operative sensation?

In the Chinese study of 49 people, no post-operative complications were observed.[1]However, it has been noted that in eyes with a high double-eyelid line, sunken eyes, or minimal eyelid fat, scars may be more visible and may not blend well with the eyebrow.[1].

Because the procedure involves handling tissue near nerves in the upper-eyebrow region, post-operative numbness or a tingling sensation may occur.[4]Tingling may sometimes be a sign that sensation is returning, according to reports.[4].

What is confirmed during consultation?

Whether eyebrow-level incision is appropriate depends on the amount and location of sagging, eyebrow height, and eyelid skin thickness.[1][2]During your consultation, make sure to have the surgeon assess whether the eyebrow is drooping and whether the strength to open the eyelid has weakened.

On top of that, confirming with your surgeon whether eyebrow-level incision alone is sufficient or whether double-eyelid surgery or brow-lift surgery should be combined will help prevent discrepancies in the final result.