Sub-Brow Lift to Correct Droopy Upper Eyelids
Under-brow incision is a droopy eyelid surgery in which an incision is made just below the eyebrow to cut away sagging upper eyelid skin.
If you opened this page because the outer corners of your eyes droop and make your expression look heavy, we will start by showing you the basic information.
Although the name includes "lift," it is not a surgery that pulls the eyebrows up. It is a surgery that cuts away excess skin below the eyebrow.
The causes of droopy eyes and the criteria for choosing a surgery are summarized in Causes of Droopy Eyes and Criteria for Choosing Surgery.
This is a surgery in which an incision is made along the border below the eyebrow and the upper eyelid skin that hangs below it is cut away.
Because the name makes this surgery easy to confuse, we will go step by step, starting with the principle.
With age, the upper eyelid skin stretches. The stretched skin tends to cover the eye, especially toward the outer corner.
Under-brow incision removes this excess skin from the eyebrow side. It does not touch the double eyelid line (eyelid crease). In the medical literature, it is called infrabrow excision or subbrow blepharoplasty.
Under-brow incision (infrabrow excision blepharoplasty) places the incision line along the border below the eyebrow, excises the lax upper eyelid skin below it and, if needed, part of the orbicularis oculi (the muscle around the eye), and then sutures. This surgery reduces the thick skin near the eyebrow and leaves the thin skin near the lashes and the existing eyelid crease as they are. Case studies of East Asian patients applied this method to cases where the outer corner of the eye is covered, where the patient wishes to keep the current double eyelid line, or where there is an eyebrow tattoo[1][2]. Upper eyelid skin becomes thicker toward the eyebrow[3].
In simple terms — This is a surgery that cuts away excess skin just below the eyebrow.
Sub-brow lift is a method in which an incision is made below the eyebrow and the sagging eyelid is pulled up, and it suits cases where the space between the eye and the eyebrow is wide. Like upper blepharoplasty, it cuts away sagging eyelid skin, but because it does not create a new double eyelid, the change in appearance is not large and the recovery period tends to be shorter.
Creates a double eyelid while removing sagging skin
Removes sagging skin without creating a separate double eyelid
In this way, the method differs depending on the shape you want and each person's condition. From the patient's side, deciding in advance whether you want a double eyelid you did not have before, or whether you do not want a change in your impression, makes the decision somewhat easier. After sagging eyelid skin is removed with middle-aged eye surgery, opening the eyes becomes much easier and the impression looks much brighter.
It is considered when upper eyelid skin covers the eye, mainly toward the outer corner.
Read the list below while picturing your own eyes in the mirror. If any apply to you, we will check at the consultation whether under-brow incision is right for you.
When your eyes feel uncomfortable
When you are concerned about how your eyes look
The surgery differs depending on where skin remains and on eye-opening strength. Skin at the outer corner calls for under-brow incision, skin all the way to the nose side calls for upper blepharoplasty, and weak eye-opening strength calls for ptosis correction.
The three surgeries work on similar areas and are easy to confuse. We have sorted them by eye condition in the table.
| Eye condition | Suitable surgery | Incision site | What the surgery does |
|---|---|---|---|
| Stretched upper eyelid skin mainly covers the outer corner of the eye. The eyelid skin tends to be thick | Under-brow incision (this page). Upper blepharoplasty is also possible | Border below the eyebrow | Excess skin close to the eyebrow is cut away |
| Stretched skin covers the entire eye, all the way to the inner corner near the nose | Upper Blepharoplasty information | Double eyelid line (eyelid crease) | Excess skin is cut away at the crease line |
| The problem is not the skin but that the eye-opening force is not transmitted well to the eyelid, so the edge of the eyelid covers the pupil | Ptosis Correction (Blepharoptosis Correction) information | For skin-side incisional ptosis correction, the double eyelid line; for conjunctival-side non-incisional ptosis correction, the inside of the eyelid (conjunctiva) | The skin side pulls and fixes the tendon sheet of the stretched eye-opening muscle. The conjunctival side reduces the accessory muscle inside the eyelid (Müller's muscle) |
| The eyebrow itself has dropped considerably and presses on the eyelid | Surgery to raise the forehead or eyebrows is discussed together | — | — |
Sometimes all three are present together. In that case, two of the surgeries may be done together.
Which of the two surgeries is right is decided through an examination. The selection criteria are summarized in more detail in Causes of Drooping Eyes and Criteria for Choosing Surgery.
A Word from the Doctor
"With the eyes in particular, the 'visible symptom' and the 'actual cause' are often different, so an accurate diagnosis is the most important."
The area to be removed is marked in a seated position, an incision is made below the eyebrow, excess skin is cut away, and the wound is stitched. Surgery takes about 1 hour.
Since it may feel vague the first time, we have laid it out step by step.
| Step | Details |
|---|---|
| 1. Design | The border below the eyebrow and the width to be removed are marked while seated |
| 2. Anesthesia | Local anesthesia is usually used. Sedation can also be added if needed |
| 3. Excision | An incision is made along the border below the eyebrow and excess skin is cut away |
| 4. Suturing | The wound is stitched so that the scar lies along the eyebrow border |
| 5. Going home |
The scar remains along the border below the eyebrow, where it meets the eyebrow hair. The scar does not disappear.
At first the incision line is red. The redness fades over several months.
The stitches are removed on day 7 after surgery, and bruising and swelling are worst in the first few days and then gradually subside. It takes several months for the scar to settle.
If you have work or an important appointment coming up, this is probably what you most want to know. We have written it by time point.
| Time point | Status |
|---|---|
| Day of surgery to a few days | The area below the eyebrow and the upper eyelid may swell and bruise |
| Day 7 | The skin stitches are removed |
| Most bruising and swelling subsides | |
| Several months | The redness of the incision line fades |
| After 6 months | The scar settles. Whether revision surgery is needed is also decided after this point |
| Activity | Time point |
|---|---|
| Going to work | |
| Washing your face | |
| Eyebrow makeup |
The speed of recovery differs from person to person. If you have an important event coming up, please tell us in advance at the consultation.
High blood pressure, aspirin use before and after surgery, vomiting after surgery, and increased activity have been reported as common factors in patients who developed the complication of blood collecting after eyelid surgery[8]. For that reason, strenuous activity is avoided for several days after surgery.
Cold compresses, sleeping position, and when to resume exercise, alcohol, and saunas:
Scars, loss of eyebrow hair, the eyebrow moving closer to the eye, a dull sensation in the forehead, differences between the left and right sides, and residual sagging can occur; rarely, blood collects or problems with vision arise.
This is information you need to know before deciding on surgery, so we have written it out in full without shortening it.
Known complications of under-brow incision are listed as wound opening, hypertrophic scars (thick, raised scars), and damage to the supraorbital artery and nerve (the nerve responsible for sensation in the forehead)[3]. In one case series, some patients reported abnormal sensation around the eyebrow, which recovered after several months[7]. In contrast, another study of 64 operated patients reported no complications related to scarring or changes in sensation[1].
The narrowing of the distance between the eyebrow and the eye after surgery was observed on the outer side in all 63 patients[5]. A review (a paper that gathers and explains multiple studies) that organized the complications of eyelid plastic surgery in general by time period listed corneal abrasion (scratching of the surface of the cornea) and retro-orbital hemorrhage (blood collecting behind the eye), which can threaten vision, within 1 week after surgery, and differences between the left and right sides, scars, and prolonged swelling after 6 weeks[9]. This review covers eyelid plastic surgery in general and does not show the frequency for under-brow incision alone.
In plain terms — This is what is reported with under-brow incision.
Across eyelid surgery as a whole, blood can rarely collect behind the eye and threaten vision.
If something feels wrong after surgery, do not put up with it on your own.
Bleeding behind the eye is reported to occur most often within 24 hours after surgery, especially within the first few hours, and in some cases it occurred a few days later[8].
Symptoms to have checked promptly
Outside clinic hours, do not wait: call 119 or go to the nearest emergency room.
Tell us at your next visit
So that you do not have to get through recovery alone, Dr. Park Jung Keun and the nursing team check on swelling, pain, and how you are feeling together.
Yes. A typical case is when the cause of the sagging is not the skin. Criteria based on your health condition are confirmed at the consultation.
This surgery is not right for every drooping eyelid.
Please tell us about all medications you take and any conditions you have at the consultation. Even things that seem minor are fine to mention.
Two representative operations considered for drooping upper eyelids are upper blepharoplasty and sub-brow lift.
— Dr. Park Jung Keun, Plastic Surgery Specialist · Face Plus Talk
A sub-brow lift is an operation performed when the upper eyelid droops, like upper blepharoplasty. The difference is that a sub-brow lift cuts and removes the skin just below the eyebrow. It is the same as upper blepharoplasty in that it removes loose skin. The difference is simply that the skin removed is not the eyelid skin but the skin just below the eyebrow. Also, unlike upper blepharoplasty, it does not create a double eyelid separately.
In general, a sub-brow lift has the advantage of a faster recovery than upper blepharoplasty. The change in impression is also relatively small. You can think of it as your eyes returning to how they looked before they drooped.
So when do we recommend upper blepharoplasty, and when a sub-brow lift? If you do not want a change in impression and want a method with a faster recovery, we recommend a sub-brow lift. If you never had a double eyelid and do not want to create one, we also recommend a sub-brow lift. By contrast, if you want a double eyelid you never had, upper blepharoplasty is necessary. Upper blepharoplasty is also considered if the skin is drooping on the inner side of the upper eyelid as well as the outer side.
In this way, the method differs depending on the shape you want and each person's condition. For the patient, it becomes easier to judge if you decide in advance only whether you want a double eyelid you did not have, or whether you do not want a change in impression. After surgery, opening your eyes will be much easier, and your impression will look much brighter.
No. Under-brow incision is a surgery that cuts away excess skin below the eyebrow. There are also reports that the distance between the eyebrow and the eye became shorter after surgery. If the eyebrow itself has dropped, surgery to raise the forehead or eyebrows is discussed together.
The incision site and the area treated are different. Under-brow incision cuts beneath the eyebrow to reduce mainly the skin toward the outer corner of the eye, while upper blepharoplasty cuts along the double eyelid line to reduce skin as far as the inner, nasal side. If only the outer corner is drooping, either operation is possible. The distinction is laid out in the comparison of the three operations.
Under-brow incision does not incise the double eyelid line. The skin and crease line at the double eyelid line are left as they are. When the skin that was covering it is reduced, a double eyelid that had been hidden may become more visible.
The scar remains along the border below the eyebrow. It is red at first and fades over several months. If your eyebrows are sparse or you do not wear makeup, it may be more visible.
This links to a video on the Face Plus Plastic Surgery YouTube channel. View All FacePlus TV
These are surgeries and procedures often discussed together with this surgery during consultations. Whether to have them together is decided after an examination.
He personally consults on and performs facial aging treatments such as facelift, droopy eyelid surgery, and thread lift. The doctor personally sees you from consultation through recovery.
About the DoctorThe content of this page is general medical information provided in accordance with the Medical Service Act, and the effects and recovery time of surgeries and procedures may vary by individual. All surgeries and procedures can cause side effects, so please make your decision only after a thorough consultation with a plastic surgery specialist.
Facelift, droopy eyelid surgery, and thread lift: Dr. Park Jung Keun personally checks every stage, from consultation to recovery. Please schedule by phone or KakaoTalk, or leave a consultation request form.
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