Brow lift — it does not smooth forehead lines, it raises brows that have dropped

For some people with deep forehead lines, the lines are not the cause but the result.

When brows drop, the field of vision feels heavy. Without noticing, you use the forehead muscle to keep lifting them, and that repetition carves horizontal lines. The lines are the mark left by propping up the brows.

Not knowing this and stopping the forehead muscle with botulinum toxin softens the lines but also removes the force that was lifting the brows. That is where 'my eyes felt heavier after forehead Botox' comes from.

A brow lift goes the other way. It raises and fixes the brows so the forehead muscle no longer has to do that job.

There are two approaches. The endoscopic one, with a few small incisions hidden in the hair, is common now; a broad forehead or a heavy descent may call for an incision running across the top of the head. The latter lifts more but brings more scarring and more change to the hairline.

The hairline can move back. This operation pulls and fixes the scalp, so an already high forehead can become higher. Keeping or lowering the forehead means putting the incision at the hairline instead, and then the scar sits outside the hair.

Sensation dulls around the incision. The forehead and crown feeling like somebody else's skin for months is common. It usually returns, though some can persist.

Hair can fall along the incision. Most grows back, but rarely the line stays bare as a scar.

Lift too much and the look is startled. Brows sit unnaturally high with a taut forehead, and it is hard to undo.

Sensory nerves can be injured. Rarely, forehead sensation changes lastingly.

If one brow is noticeably higher, or one side of the forehead will not move, report it.

Settle the order with any eyelid surgery. With the brows already down, doing only double eyelid or ptosis correction can pull the brows down further by the amount of lid skin removed. Which comes first is a matter for consultation.

In front of a mirror, lift your brows slightly with your fingers. If that is close to what you want, this operation may be for you. If nothing changes, the problem is the lid, not the brow.

Measure the height of your forehead first. A naturally high forehead changes which approach fits.

Not smoking matters. Once the scalp is lifted, that tissue survives on blood flow from its edges.

Do not wash or brush your hair vigorously for the first few weeks.

It cannot be undone. Fixed tissue and a moved hairline do not return.

It looks like it shares a purpose with botulinum toxin, but the direction is opposite. Toxin stops the forehead muscle to soften the lines; this operation raises the brows so that muscle has no reason to work. In someone whose brows have dropped, toxin alone adds to the heaviness.

Ageing continues. This sets things once; it does not stop the clock.

The forehead lines themselves can remain. Deeply etched lines stay as lines even once the brows are up, and those belong to fractional laser or toxin.

Whether to have it done is settled with a doctor, and it is better not to settle it on one consultation alone.