Traditionally, it’s said that the eyebrow position should be on or just above the bony framework of the eye socket. While this is mostly true, it’s simplistic; eyebrow height is only one of the variables. In many people, the outer edge of the eyebrow droops more than the inner edge, causing changes in eyebrow shape. Furthermore, age-related changes in the eyebrow don’t occur independently. The upper eyelid crease deepens due to fat loss, excess eyelid skin becomes more prominent, and a certain degree of upper eyelid drooping occurs. As a result, a reflex eyebrow lift occurs, with the inner edge of the eyebrow being lifted more than the outer edge. There is a very close relationship between eyebrow position and the eyelid. The visible eyelid, from the lashes to the eyelid crease, should be about one-third, or at most half, the distance from the lashes to the lower edge of the eyebrow. Some factors that alter this ratio include: changes in eyebrow height, eyelid drooping or retraction, excess upper eyelid soft tissue, and loss of fat tissue in the upper crease. These problems can be solved independently or in combination with an eyebrow lift. Eyebrow repositioning creates a powerful effect; however, it should always be considered in conjunction with other options such as eyelid drooping repair, blepharoplasty (eyelid surgery), and fat injection into the upper eyelid crease. Many patients are unaware of the numerous variables affecting periorbital rejuvenation and may not want the multiple treatment methods required to correct all these elements. Therefore, it is crucial to identify the main components of periorbital aging in each patient.

Previous photographs are quite helpful in understanding which age-related changes are dominant. Many different surgical and non-surgical methods (Botox, thread lifts, etc.) have been described for eyebrow lifting and forehead rejuvenation. The appropriate method for each patient should be determined after a detailed facial analysis, taking into account the patient’s expectations and desires. Eyebrow lifting is usually performed simultaneously with other procedures such as blepharoplasty and facelift, and is generally performed endoscopically or via direct vision through 4 cm incisions on each side, made within the hairline. After the forehead skin and the outer edge of the eyebrow are freed from their attachments to the underlying tissue, this loosened skin and soft tissues are suspended to the upper region using various fixation methods. These include screw fixation, fixation with absorbable devices, and suture fixation of soft tissue and connective tissue. Screw fixation is effective; however, it needs to be removed with a further procedure after three weeks. Absorbable fixation material (endotine) is applied by attaching its lower end to the soft tissue above the eyebrow (to the cheek area in mid-face lifts) and its upper end to the skull; it is an effective method and does not require a second procedure, but it is quite expensive. Suspension of soft tissues to connective tissue with sutures is currently the most frequently used method, does not require a secondary procedure, and does not require additional material supply. Since the main goal in eyebrow lifting, which used to be excessive and unnatural-looking, is no longer to achieve excessively high eyebrows, this method gives us a satisfactory result. Although the hairline and scalp approach (open coronal approach), where the entry point is parallel to the forehead, is not commonly used today, it is an effective and long-lasting method in forehead rejuvenation, but it has been replaced by less invasive techniques.