Brow lifts are performed to elevate the eyebrows and position them in a more youthful position. As we age, often times the eyebrows become droopy and hang lower on the face and closer to the upper eyelid. This may create a tired, older, and often “sad” appearance. In addition to changes in the position of the eyebrow - the shape is affected by age as well. There appears to be a heaviness to the lateral aspects of the eyebrows, more so than the medial (or nasal) aspects. This has a negative affect on the youthful eyebrow peak and creates a droopier appearance - necessitating a brow lift procedure. Modest elevation of the eyebrows and improvement in eyebrow shape can be achieved with botox, although this is temporary and must be repeated to maintain the effects. A brow lift procedure may be achieved with different surgical approaches. The decision regarding the surgical approach depends on several factors, including patient desires, anatomy of the patient (forehead length and shape, degree of lift needed, etc). The approaches to perform a brow lift include an endoscopic approach, open approach with a pretrichal incision (anterior hairline incision), or a transpalpebral approach (performed during an upper eyelid blepharoplasty using the same incision). The endoscopic approach uses 5 small (2-5cm incisions) in the hair-bearing area of the scalp and a camera to perform the brow lift procedure. The pretrichal approach is performed using an anterior hairline incision conceals the scar along the hairline. This approach has the benefit of shortening the forehead and achieving a lower hairline as well. Modest elevation and support of the eyebrow can also be performed during an upper eyelid blepharoplasty incision. This is not as effective as the other approaches but may provide some benefit.