Brow Thread Lift

What Is a Brow Thread Lift?

A brow thread lift gives the brow upward support by placing medical threads under the skin of the forehead or temple; the threads have small barbs on their surface that grip the tissue. It usually needs no surgical incision, and no skin is removed. The method is a thread lift adapted to the brow and forehead. The procedure is also called a “forehead thread lift”; however, because what it actually does is lift the brow, some authors consider “brow thread lift” the more accurate name.

The method is based on placing barbed threads along set lines to lift tissue that has descended. Its safety depends on a good knowledge of the blood vessels and muscles of the forehead and brow, and of the changes that come with age. According to a study of the anatomy of the brow area, placing I-shaped threads beneath the forehead muscle is a safer option than the traditional U-shaped placement.

According to a publication based on case reports, a brow thread lift is an intermediate step between surgical and non-surgical methods: it gives a subtler change than surgery, its effect fades over time, and it may need to be repeated.

RELATEDFillers or a Thread Lift?

SOURCEPMID 39135300PMID 30893160PMID 39884674

Has the Brow Really Dropped, or Has the Eyelid Become Heavy?

Your brow may look low, but that does not always mean it has dropped. Studies of how brow position changes with age have also produced results that differ from the common belief, and this difference directly affects which method is worth discussing.

An analysis pooling data from a total of 3,634 people in 19 studies found that, with age, the inner end and middle part of the brow rose, while the outer end, at the level of the outer corner of the eye, showed no significant change. In other words, on average the brow does not descend as a whole; different parts of the brow can change in different directions.

A study comparing 95 adults in three age groups also found no significant difference in brow height between the groups. The same study found that the forehead muscle worked more actively with age, and that excess skin on the upper eyelid (dermatochalasis) increased as brow height decreased. The researchers think that brow position is maintained by muscles working to balance one another.

What this means for you: the heaviness you see on your upper eyelid can come from the position of the brow or from excess eyelid skin; both can also be present in the same person. Drooping brows have also been reported to be common in people seeking eyelid surgery. Which one is dominant becomes clear at a consultation, not in the mirror.

RELATEDWhy does the face sag?

SOURCEPMID 31942395PMID 26818320PMID 39135300

The Forehead Muscle and Brow Movement

The muscle that raises the brow is the forehead muscle (frontalis), and the part that actually moves the brow is its lower end. A brow thread lift is performed in the area where the forehead muscle meets the ring-shaped muscle around the eye.

According to an anatomical study combining cadaver, imaging and clinical observation data, the forehead muscle is firmly attached to the deep fascia (a thin sheet of connective tissue) in the upper and middle forehead. In the lower third, it separates from this layer and interlaces with the ring-shaped muscle around the eye (orbicularis oculi). In the same study, the brow rose only when this lower part of the muscle was pulled; the muscle moves the brow by contracting from its lower end towards its middle.

According to a review of the anatomy of brow thread lifting, it is important to know the nerve and blood vessel pathways in this area well, especially the supratrochlear and supraorbital vessels (vessels that run up into the forehead from the upper rim of the eye socket). Assessing how mobile the tissue is and how it is attached to the underlying structures before the procedure is also seen as key to predicting the result. The forehead has little subcutaneous fat (the fat layer under the skin), so the layer in which the thread is placed requires precise anatomical knowledge. In people whose tissue is firmly attached to the underlying structures, working through a partial tunnel made with a cannula (a fine, flexible tube with a blunt tip) has been reported. At the clinic, the doctor chooses a needle or a cannula for each person, based on the treatment area and their anatomy.

SOURCEPMID 37768166PMID 39884674PMID 39135300

The Temple and the Temporal Branch of the Facial Nerve

The temple, which the threads can pass through in a brow thread lift, also contains the temporal branch of the facial nerve. This branch controls the forehead muscle. If it is damaged, problems that affect both function and appearance can occur, such as being unable to raise the brow.

The temporal branch controls many muscles of the upper face and is needed for facial expressions and for closing the eyelids. The path it takes varies from person to person. Some anatomical landmarks help to estimate where it lies, but they do not give an exact map.

A cadaver study found considerable variation in how this branch is distributed in the temple and concluded that there is no truly safe zone in the temple, only relatively safe zones. In another cadaver study, after crossing the arch of the cheekbone, the branch crossed the temple along a forward-curving line and reached the forehead muscle near the outer end of the brow.

Knowing the course of the facial nerve is necessary to reduce the risk of nerve damage, such as facial weakness or paralysis. This information does not show that the risk is common; it explains why the area requires detailed anatomical knowledge.

RELATEDFox Eye / Cat Eye Thread Lift

SOURCEPMID 40268626PMID 25342224PMID 37652939PMID 39376117

What Does the Research Say About Brow Thread Lifts?

Scientific evidence on brow thread lifts is still limited. Publications specific to the brow are based on small case series with no control group, case reports and reviews. Among the sources reviewed, there are no randomised trials (trials in which participants are randomly assigned to groups) comparing a brow thread lift with a control group or with another method.

In a series of 38 women reported from a single institution, a brow thread lift was performed in people with mild to moderate drooping brows or with no droop at all. On a scale based on patients’ own assessment (FACE-Q), brow and upper eyelid scores had improved from baseline at six months, and the significant increase was still present at 12 months. No serious complications were reported; the improvement was more marked in younger women. The participants’ average age was 35.5, and the study had no control group.

In another series of 15 people, the brows measured lower than at baseline one week after the procedure, while at 12 weeks the brow and upper eyelid were significantly higher than at baseline. This finding suggests that the early appearance may not reflect the result; however, this too is a small, uncontrolled series.

According to a publication based on case reports, a brow thread lift gives a subtler improvement than surgery, the procedure can be uncomfortable, the effect lasts about six months, and repeat treatment is needed as it fades. These differences between series do not show how long the effect can be expected to last for any one person.

The picture is similar for the face as a whole. A systematic review in this field found that in all but two of the studies examined, the lifting effect lasted a very limited time at most; the two studies reporting positive results were supported by thread manufacturers. A more recent review also stated that no new evidence supporting the method had been added.

SOURCEPMID 35441792PMID 37060183PMID 39135300PMID 29481392PMID 33471152

Limits of This Treatment

A brow thread lift is not a substitute for a surgical brow lift. It does not remove excess skin from the upper eyelid, and its effect is not permanent. These three limits define what you can expect from the treatment.

First, the scale of the effect is limited. The result is subtler than with surgery; the method is seen as an intermediate step between surgical and non-surgical treatments. According to a review of brow lift techniques, no brow lift method, surgical or non-surgical, is entirely satisfactory; the reasons are limited effect, limited longevity and possible complications.

Second, the duration is uncertain. It is not clear how effective techniques using dissolvable threads are in the long term. In an analysis pooling data from many studies of facial thread lifts (a meta-analysis), the satisfaction rate was 98% immediately after the procedure and 88% in the long term, and this difference is significant. The researchers recommend discussing before the procedure that the rejuvenating effect may not last in the long term.

Third, excess skin is a separate problem. Threads support tissue; they do not remove skin. If the heaviness you see comes from the skin of the upper eyelid, this is assessed separately in the relevant surgical specialty. These limits are not a reason to rule the treatment out; they show what you can expect. Your doctor assesses you; the decision is yours.

SOURCEPMID 39135300PMID 32308957PMID 30893160PMID 33821308

How It Differs from Botulinum Toxin for Brow Lifting

A brow lift with botulinum toxin uses no threads. The movement of the muscles that pull the brow down is temporarily reduced, and the position of the brow changes through the muscle balance. This treatment uses botulinum toxin, often called Botox®; that everyday name comes from the name of a product. It aims for a similar goal to a brow thread lift, but through a different mechanism.

A review of 11 studies and 585 patients that used objective measurements to examine botulinum toxin for brow shaping found the greatest lift in the outer part of the brow. It reported that different brow shapes can be achieved by targeting different muscle groups. The most commonly reported side effects were bruising and headache; a drooping eyelid (ptosis) occurred in five cases. The researchers nonetheless state that new randomised trials are needed.

This method has a subtlety of its own: because the forehead muscle is the muscle that raises the brow, treating this muscle can also lower the brow. In a randomised controlled trial in which the muscles that pull the brow down were also treated, the forehead muscle was injected in three different patterns. Two weeks later, the brow was lower at every measured point except its outer end, where it was higher; injections into the upper part of the forehead were found to reduce the risk of a drooping brow.

Put simply, threads mechanically lift the tissue that holds the brow, while botulinum toxin changes the balance of the muscles acting on the brow. According to a review of brow lift techniques, non-surgical methods are temporary, and correction is easier if a complication occurs. Whether one of the two methods, both together or neither will be considered is decided at a consultation.

RELATEDBotulinum Toxin for Brow Lifting

SOURCEPMID 33065951PMID 30102667PMID 32308957

How It Differs from a Surgical Brow Lift

A surgical brow lift is an operation in which incisions are made in the skin and the tissue is repositioned; it works on a different scale from a brow thread lift. Its assessment and the operation itself belong to the relevant surgical specialty; the information here is only to help you compare the two methods.

According to a review of brow lift techniques, surgical methods fall into three groups: those performed through an eyelid surgery incision, those performed directly above the brow, and those performed through the forehead or scalp. The most common method is the endoscopic forehead lift (performed through small incisions using a camera), but its longevity is also limited. A direct brow lift, on the other hand, is found useful in people who have facial weakness or paralysis and are more willing to accept scarring.

A meta-analysis of long-term results assessed 2,127 brows in 22 studies with an average follow-up of at least six months. In these data, with a weighted average follow-up of 20.9 months, the outer, middle and inner parts of the brow rose significantly. The researchers stated that these results support the long-term effectiveness and favourable safety profile of surgical brow lifts.

A review of 15 studies comparing open and endoscopic techniques found that endoscopic and less invasive techniques (those that disturb the tissue less) gave similar or better aesthetic results with a lower complication rate; however, differences between the studies limit the strength of this conclusion. Surgery has its own risks too: in direct brow operations performed through the temple, injury to the temporal branch of the facial nerve and the resulting brow paralysis are among the main complications described. The difference between threads and surgery is not one of degree; they are two separate methods that work on different scales.

SOURCEPMID 32308957PMID 40788666PMID 41710188PMID 37652939

Known Risks

There are no large-scale risk data specific to brow thread lifts; the rates below apply to all thread treatments of the face and neck. The most commonly reported effects are swelling, bruising and asymmetry (the two sides not looking the same). Dimpling, and threads that can be seen or felt, are among the findings that can persist beyond the first few weeks.

A meta-analysis covering 26 studies and 2,827 patients reported swelling in 34%, bruising in 26%, threads that could be seen or felt by hand in 10%, and skin dimpling in 7%. The researchers note that the variation between studies was very high, and that findings lasting beyond the first four weeks may be more clinically important.

In a review covering 14,222 patients, the most commonly reported finding was asymmetry, followed by swelling (oedema) and bruising. Serious side effects are rare; these are altered sensation, hair loss, and injury to blood vessels or glands. Another meta-analysis found that, with dissolvable threads, the risk of altered sensation and of the thread coming out through the skin was lower than with permanent threads, while in people over 50 the risk of dimpling and infection was higher. A review comparing dissolvable threads also reported that barbed threads were associated with more complications than smooth (non-barbed) threads.

Nerve injury is uncommon, but it is a recognised risk. In a series of 190 patients who presented with complications after thread treatments carried out elsewhere, five patients had partial facial paralysis; the researchers identified insufficient knowledge of the anatomy as the main cause. In the temple, isolated cases have been reported of an abnormal connection between the superficial temporal blood vessels (arteriovenous fistula) after a brow thread lift, and of a blood-filled sac (pseudoaneurysm) in the superficial temporal artery, caused by damage to the vessel wall, after a facial thread lift; both were noticed as a pulsating swelling.

Before the procedure, you will be asked about blood thinners, antiplatelet medicines (they stop blood platelets from clumping together) and supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor.

RELATEDWhat to look out for after a thread lift

SOURCEPMID 41988336PMID 34699439PMID 33821308PMID 39442180PMID 34549008PMID 37388255PMID 41468260PMID 39760325

Which Threads Are Used?

Threads used for lifting fall into two groups: dissolvable (absorbable) and permanent (non-absorbable). According to the sources, early treatments with permanent barbed threads had high rates of corrective procedures and complications. Techniques developed with dissolvable threads have shown fewer adverse effects; however, it is not clear how effective these techniques are in the long term. A meta-analysis also found that dissolvable threads carried a significantly lower risk of altered sensation and of the thread coming out through the skin than permanent threads, and recommended that permanent threads be used with caution.

At the clinic, dissolvable threads (PLLA/PDO, that is, poly-L-lactic acid and polydioxanone) are used. “Thread lift” is the general name for lifting treatments performed with threads; the French Thread Lift is one of the techniques within these methods. A brow thread lift is the treatment in this family designed for the brow and forehead.

When a dissolvable thread dissolves, this does not mean that the effect will end at that moment, nor that it will be permanent; data on this are limited. At the consultation, your doctor decides which thread to use, in which direction, and in which layer to place it.

RELATEDFrench Thread Lift

SOURCEPMID 30893160PMID 33821308