Leaving the double eyelid line as it is,a sub-brow lift that works from beneath the brow

Sub-brow Lift (Lift with Incision Below the Brow)

A sub-brow lift removes skin just below the eyebrow to raise a sagging upper eyelid, and can correct sagging while keeping the existing double eyelid line.

Overview

Correction of upper-eyelid sagging divides into two approaches by where the skin is removed: upper blepharoplasty, which removes skin at the double eyelid line, and the sub-brow lift, which removes it just below the eyebrow. A sub-brow lift removes loose skin along the lower border of the brow to raise sagging on the outer part of the eyelid. The incision sits along the lower brow border and is hidden by the brow, and the existing double eyelid line is left untouched.

There are cases where this surgery is especially suitable: when the brow-to-eye distance is short and removing skin with upper blepharoplasty could pull the brow down further; when outer eyelid sagging is pronounced and the outer corners droop; and when you do not want to create or change a double eyelid line. Because Asians tend to have a short brow-to-eye distance and thicker eyelids, there are many cases where a sub-brow lift can be expected to give a more natural result than upper blepharoplasty.

At Atelier Plastic Surgery we check the height and shape of the brow, the brow-to-eye distance, and whether the sagging is concentrated on the inner or outer part of the eyelid to decide whether upper blepharoplasty or a sub-brow lift is right, or how to divide the two between them. Consultation, surgery, and follow-up are handled personally by the director.

Recommended for

Your upper eyelid has sagged, but you want to keep your existing double eyelid line as it is
Your brow-to-eye distance is short, and you worry that upper blepharoplasty would pull the brow down further
Outer eyelid sagging is pronounced, the outer corners droop, and your face looks heavy
Your eyelids are thick, and you worry that an incision at the double eyelid line would make the line look thick
Your vision is obstructed starting from the outer side
You have brow tattooing or full brows that can hide the incision line

Surgery & treatment methods

Lift with incision along the lower brow border

A crescent of loose skin is removed along the lower border of the brow and closed. The width removed is set by the degree of sagging and the brow-to-eye distance, with more removed on the outer side to lift the drooping outer corner.

Suited for · When outer eyelid sagging is the main problem

Combined orbicularis fixation

Along with skin removal, the orbicularis muscle is fixed to the periosteum above so that the lifting effect lasts longer. The pull is more stable than with skin removal alone.

Suited for · When sagging is pronounced or you want a longer-lasting result

Combined with upper blepharoplasty

Inner sagging is removed at the double eyelid line and outer sagging below the brow, dividing the removal between the two sites. This avoids over-removal at either site and preserves brow position.

Suited for · When both inner and outer sagging are present

Illustrations & photos

Key facts

Surgery time: About 1 hour
Anesthesia: Local anesthesia (with sedation if needed)
Hospital stay: None (same-day discharge)
Stitch removal: About 5–7 days
Return to daily life: About 1–2 weeks
Follow-up visits: After surgery: stitch removal · 1 month · 3 months

These may vary depending on your condition; we will give you precise details at your consultation.

Atelier Plastic Surgery's approach

01
Preserving brow position comes first
If only skin near the double eyelid line is removed while the brow has already dropped, the brow drops further and the face looks heavy. We measure the brow-to-eye distance to judge whether removing skin below the brow is the better choice.
02
We place the incision precisely at the brow border
An incision that strays from the lower brow border becomes a noticeable scar. We cut at an angle following the direction of the brow hairs to reduce damage to the follicles, so that the suture line is hidden by the brow.
03
We look at the outer and inner parts separately
Eyelid sagging often begins on the outer side. We vary the width removed according to where the sagging is concentrated, and if inner sagging is also present we consider combining upper blepharoplasty.
04
We do not change the double eyelid line
Many people are used to their existing line. We lift only the sagging without creating a new line, planning so that your original eye shape is preserved after surgery.

After surgery

Day of surgery
Begin cold compresses and rest with your head elevated. You go home the same day and take the prescribed medication. Avoid moving your forehead and brow area excessively.
Days 2–3
Swelling and bruising are at their peak. Continue cold compresses and apply the prescribed ointment to the incision sites.
Days 5–7
Stitches are removed. You can wash your face after stitch removal, and swelling decreases noticeably.
2 weeks
Major swelling subsides and daily activities are possible. Start brow makeup after the incision has healed.
1–3 months
The incision line may look red but gradually fades. Reduced sensation and stiffness around the brow gradually recover.
6 months
The final shape settles and the scar stabilizes. Recovery speed and results vary from person to person.

Recovery care and the aftercare schedule are described in the Safety Care System. Safety Care System

Side effects · Precautions

Bleeding and hematoma, infection, swelling, and bruising may occur. The incision line remains along the lower brow border, and it may be noticeable if your brows are sparse or you are prone to scarring. Asymmetry in brow height or shape, loss of some brow hairs, and reduced sensation or tingling in the forehead and brow area may occur; these mostly recover, but some may persist. Removing too much skin can cause incomplete eye closure and dry eye, while removing too little can leave sagging behind. The brow shape may change in unwanted ways or the brow-to-eye distance may look wider, and revision surgery may be needed depending on the result. Outcomes vary from person to person, and we explain the risks and limitations fully at consultation.

The content on this page is general medical information provided in accordance with the Medical Service Act. The results of surgery and treatments and the recovery period may vary by individual. All surgeries and treatments carry a risk of side effects, so please decide after a thorough consultation with a specialist.

FAQ

Q1Will the scar be noticeable?

The incision sits along the lower brow border and is hidden by the brow. It may look red at first but generally fades over several months. If your brows are sparse or you shave and draw them in, the scar may be relatively more visible, so we check this in advance at consultation.

Q2How does it differ from upper blepharoplasty?

The site of skin removal differs. Upper blepharoplasty removes skin at the double eyelid line; a sub-brow lift removes it below the brow. A sub-brow lift may be more suitable when the brow-to-eye distance is short, outer sagging is pronounced, or you want to keep your existing double eyelid line.

Q3Will my brow shape change?

Because the skin is removed along the lower brow border, the position of the brow itself does not change much. However, depending on the width removed, the brow-to-eye distance may widen slightly, so we confirm the eye shape you want at consultation.

Q4Is it possible if I have brow tattooing?

Yes. Setting the incision along the tattoo border can even help conceal the scar. However, if the tattoo sits differently from your actual brow, the incision position needs adjusting, so we check this at consultation.

Q5How long does the result last?

Aging continues, so the skin may loosen again over time. Fixing the orbicularis muscle helps the result last longer than skin removal alone. How long it lasts depends on your skin condition and varies from person to person.

Q6Can it be done under local anesthesia alone, without sedation?

Yes. It can be performed under local anesthesia alone, and sedation is added if you are very anxious. When sedation is used, we work together with a board-certified anesthesiologist.

Related Upper Blepharoplasty

Upper blepharoplasty that removes only as much loose upper-eyelid skin as needed to improve both vision and appearance

Double eyelid surgery and ptosis correction, with the extent of incision chosen by eyelid thickness and opening strength

Lower blepharoplasty that tidies loose skin and bulging fat and reinforces the supporting structure

A guide to choosing eye surgery by sagging, opening strength, and eye exposure

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