Browlift Risks

A brow lift — also known as a forehead lift or browplasty — repositions descended brow and forehead tissues through incisions placed within or near the hairline, or in some techniques directly above the brow. While it is less extensive than procedures such as a deep plane facelift, it is still invasive surgery performed on the upper face, a region containing important nerves, blood vessels, and hair-bearing tissue. It carries a range of risks that must be understood before consenting to the procedure.

The nature and likelihood of each complication varies between individuals and depends on factors including the surgical technique used, your anatomy, skin type and quality, whether you smoke, your general health, and how closely post-operative care instructions are followed. Some risks are common to all brow lift techniques; others are more specific to particular approaches.

Dr Roth (MED0001185485), Specialist Otolaryngologist & Head and Neck Surgeon (specialist registration — Otorhinolaryngology, Head & Neck Surgery), will assess your individual circumstances and discuss these risks with you in detail before any surgery proceeds.

1. Anaesthesia Risks

A brow lift is performed under general anaesthesia or deep sedation in an accredited surgical facility. General anaesthesia carries its own set of risks, separate from the surgical risks of the procedure itself. A pre-anaesthetic assessment will be conducted before your surgery, and you will be reviewed by the anaesthetist prior to the procedure.

Risks associated with general anaesthesia include:

• Nausea and vomiting: Common in the immediate post-operative period. Anti-nausea medications are routinely used to minimise this.
• Sore throat: Caused by the breathing tube placed during anaesthesia. Usually resolves within one to two days.
• Temporary confusion or disorientation: More common in older patients. Resolves as the anaesthetic clears.
• Adverse drug reactions: Reactions to anaesthetic agents can range from mild to, rarely, severe. Your anaesthetist will discuss your personal risk at the pre-operative assessment.
• Respiratory complications: Including chest infection or breathing difficulties. Risk is higher in patients with pre-existing lung conditions or those who smoke.
• Deep vein thrombosis (DVT) and pulmonary embolism: Blood clots in the deep veins of the legs can, in rare cases, travel to the lungs. Risk is low for short procedures in healthy patients but increases with certain risk factors. Preventative measures are taken routinely.
• Serious cardiac or respiratory events: Extremely rare in healthy patients undergoing elective procedures in accredited facilities, but a recognised possibility that will be discussed based on your individual medical history.

You must inform Dr Roth and your anaesthetist of all medications, supplements, allergies, previous anaesthetic reactions, and any relevant medical history prior to surgery.

2. Bleeding and Haematoma

Some bleeding during and immediately after surgery is normal and expected. A haematoma is a collection of blood that accumulates in the surgical site after the wound has been closed. In brow lift surgery, haematoma formation is uncommon but can occur in any of the tissue planes elevated during the procedure.

A small haematoma may resolve on its own. A larger haematoma can cause significant swelling, tension on the wound, discolouration, and discomfort, and may require drainage — either in the clinic or in a return to theatre. If not managed appropriately, a haematoma can impair wound healing and increase the risk of scarring, prolonged swelling, and infection.

To reduce bleeding risk, you will be advised to stop blood-thinning medications and supplements — including aspirin, ibuprofen, fish oil, vitamin E, and certain herbal supplements — for at least two weeks before surgery. Alcohol should also be avoided in the days before and after the procedure. All medications and supplements must be disclosed at your consultation.

Post-operatively, strenuous activity, heavy lifting, and bending should be avoided for at least four weeks, as raised blood pressure increases the risk of delayed bleeding.

3. Hair Loss Around the Incisions

Hair loss in the vicinity of surgical incisions is a recognised risk of brow lift surgery and is one of the more frequently discussed concerns in patients with hair-bearing incisions — particularly with the endoscopic, trichophytic, coronal, and lateral temporal approaches.

Two distinct patterns of hair loss can occur:

• Temporary hair loss (telogen effluvium): Surgical trauma, tension on the scalp tissues, and the physiological stress of surgery can push hair follicles in and around the incision into a resting phase, causing temporary shedding in the weeks following surgery. This is called telogen effluvium. In most cases, hair regrowth occurs over the following three to six months as the follicles re-enter the growth phase. Patients should be aware that this shedding can be noticeable and distressing in the interim.
• Permanent hair loss: If hair follicles are directly damaged during incision placement, cauterisation, or healing — or if the blood supply to a segment of scalp is compromised — permanent loss of hair along or near the incision line can occur. The trichophytic incision technique is specifically designed to reduce this risk by allowing hair to regrow through the scar; however, no technique eliminates permanent hair loss entirely.

The risk of significant hair loss is higher if healing is complicated by infection, haematoma, or wound breakdown. Patients with a history of hair loss conditions (such as alopecia) should discuss this with Dr Roth prior to surgery, as this may influence technique selection or the decision to proceed.

4. Elevated or Altered Hairline

Some brow lift techniques — particularly the coronal approach — involve removal of a strip of scalp tissue, which shortens the distance between the hairline and the eyebrows. In patients who already have a high forehead or a naturally high hairline, this can result in a further elevation of the hairline that may be cosmetically noticeable.

The trichophytic (hairline) approach is specifically designed to address this concern: the incision is placed just behind the hairline rather than within the hair-bearing scalp, allowing the surgeon to shorten the forehead without raising the hairline. For patients with a high forehead, this technique may be the most appropriate choice.

The endoscopic technique does not remove skin and therefore does not raise the hairline directly, though very significant brow elevation may secondarily influence the hairline’s apparent position in some patients.

Additionally, the positioning or contour of the hairline can be subtly altered by scarring, by the direction of tissue repositioning, or by incision placement near the temples. Distortion of the temporal hairline — including a step-shaped irregularity behind the ear — is a specific concern that Dr Roth takes care to avoid through incision planning. This risk and the most appropriate technique for your anatomy will be discussed at consultation.

5. Eye Irritation and Dryness

Following a brow lift, particularly where the brow is elevated significantly or where surgery is combined with upper eyelid blepharoplasty, some patients experience temporary eye irritation, dryness, or a gritty sensation. These symptoms can occur for several reasons:

• Incomplete eye closure (lagophthalmos): Elevation of the brow and forehead tissues can, in the early post-operative period, reduce the ease with which the upper eyelid closes fully. This incomplete closure exposes the surface of the eye to drying, and can cause irritation, redness, and in more prolonged cases, corneal abrasion. This is usually temporary, resolving as swelling subsides and tissues settle. Lubricating eye drops and ointments, and sometimes protective eye taping at night, are used to manage this during the healing phase.
• Pre-existing dry eye: Patients with existing dry eye syndrome may find their symptoms worsen after brow lift surgery, particularly if it is combined with blepharoplasty. Pre-existing dry eye is assessed as part of the consultation and may influence surgical planning.
• Altered eyelid position: Changes to brow height can secondarily influence how the eyelids sit and move. In some cases this resolves as tissues settle; in others it may be an ongoing consideration.

Significant or prolonged eye symptoms after surgery should be reported to Dr Roth promptly. Corneal complications, while uncommon, require early assessment and management to prevent lasting effects on vision.

6. Facial Asymmetry

No face is perfectly symmetrical before surgery, and a meaningful degree of pre-existing asymmetry in brow height, forehead contour, and eyelid position is common. This is carefully assessed and documented at consultation so that it can be accounted for in surgical planning.

Despite careful planning and precise technique, some degree of asymmetry in the post-operative result is possible. Contributing factors include:

• Pre-existing asymmetry that influences how each side responds to the same degree of elevation
• Differential healing, swelling, and scar contraction between the two sides — very common in the early healing phase, usually resolving over weeks to months
• Variation in how the fixation devices (sutures, screws, or absorbable anchors used in endoscopic surgery) hold on each side during healing
• Asymmetric relaxation of the lifted tissues over time as the result matures

Mild asymmetry that persists after full healing may be addressable with minor revision under local anaesthesia, such as targeted neurotoxin injections to adjust brow position. More significant asymmetry may require a formal revision surgical procedure. Patients should be aware that revision surgery carries its own risks and that further improvement, while often achievable, cannot be guaranteed.

7. Numbness and Altered Sensation

Altered sensation in the forehead and scalp is one of the most consistently reported side effects of brow lift surgery and affects the majority of patients to some degree. The forehead and scalp are supplied by branches of the supraorbital and supratrochlear nerves, which travel upwards from the brow into the scalp. Surgical elevation of the forehead and scalp tissues inevitably stretches, displaces, or cuts across small sensory nerve branches.

Patients may experience:

• Numbness: Reduced or absent sensation in the forehead, scalp behind the incision, or around the temples. This is extremely common in the post-operative period and often extends further across the scalp than patients anticipate.
• Itching: As nerve fibres begin to regenerate, itching is a normal — though sometimes uncomfortable — part of the recovery process. It can persist for several months.
• Hypersensitivity: Some patients experience an increased sensitivity or hypersensitivity to touch in the healing area, which may be temporarily uncomfortable.
• Pins and needles (paraesthesia): Tingling sensations are common during the nerve regeneration phase.

In most patients, sensation gradually recovers over the months following surgery as small nerve fibres regenerate. However, the timeline varies considerably. In some patients, areas of reduced sensation in the scalp — particularly behind the incision line in coronal or trichophytic approaches — may persist for a year or longer. In a smaller number of patients, some degree of permanent altered sensation remains. This is generally more likely with the coronal technique due to the extent of scalp elevation involved.

Patients should be aware during the period of reduced sensation that the affected skin is more vulnerable to inadvertent injury, particularly from heat (hair dryers, heated styling tools). Care should be taken until normal sensation returns.

8. Facial Nerve Injury — Weakness or Paralysis

Injury to the motor branches of the facial nerve is one of the more serious potential complications of brow lift surgery. The facial nerve controls the muscles of facial expression, and branches of it — particularly the frontal (temporal) branch — travel through the tissue planes elevated during a brow lift.

The frontal branch of the facial nerve controls the frontalis muscle, which is responsible for raising the eyebrows. Injury to this branch can result in weakness or, in more severe cases, paralysis of the forehead and brow on the affected side, causing an inability to raise the brow and a flattened forehead appearance.

Two types of nerve injury can occur:

• Neurapraxia (temporary injury): The nerve is stretched, compressed, or subjected to thermal injury but remains structurally intact. Function is temporarily impaired but typically recovers over weeks to months as the nerve heals. This is the most common type of nerve-related complication in brow lift surgery and the majority of cases resolve fully.
• Neurotmesis (permanent injury): The nerve is divided or irreversibly damaged. Permanent weakness or paralysis results. This is rare in primary brow lift surgery performed by an experienced surgeon with thorough knowledge of the relevant anatomy, but it is a recognised risk that must be disclosed. The risk is higher in revision surgery where normal anatomical planes have been altered by previous procedures.

A thorough understanding of the course of the frontal branch of the facial nerve, and careful surgical technique within the appropriate tissue planes, are the principal means by which this risk is minimised. Dr Roth will discuss this risk in the context of the specific technique planned for your surgery.

9. Fluid Accumulation (Seroma)

A seroma is a collection of serous fluid — the clear, protein-rich fluid that normally lubricates tissue planes — that accumulates in the space created by the surgical dissection. In brow lift surgery, seromas are uncommon but can occur, particularly in the subperiosteal or subgaleal planes elevated during endoscopic or coronal procedures.

A seroma typically presents as a soft, fluctuant swelling in the forehead or temporal region that becomes noticeable once the initial post-operative swelling begins to subside, usually in the second week after surgery. Small seromas may resolve spontaneously with time and compression. Larger or persistent seromas may require aspiration — drainage using a fine needle — which is a simple clinic procedure. Occasionally, seromas recur and require repeated aspiration.

If a seroma becomes infected, more extensive treatment may be required. Early identification and appropriate management of seromas reduces the risk of complications including prolonged healing, pressure effects on overlying skin, and increased scarring.

10. Suture Extrusion

In endoscopic brow lift surgery, the elevated forehead tissues are secured internally using sutures, small titanium or absorbable screws, or absorbable fixation devices anchored to the skull or deep tissues. On occasion, these fixation materials — particularly permanent sutures or screws — can be felt beneath the skin, cause localised irritation, or extrude (work their way to the surface of the skin).

Suture extrusion typically presents as a small area of redness or a palpable hard nodule beneath the scalp, sometimes with a small break in the overlying skin through which the suture material is visible. Once identified, extruded sutures usually need to be removed, which is a minor procedure performed in the clinic. In most cases, removal resolves the issue without affecting the overall result, provided the forehead tissues are adequately healed and no longer require the fixation for support.

The use of absorbable fixation devices, where appropriate, reduces the long-term risk of suture extrusion. Dr Roth will discuss the fixation method planned for your surgery at consultation.

11. Infection

Infection following brow lift surgery is uncommon. The scalp and forehead have a rich blood supply, which supports healing and reduces infection risk. However, as with any surgical procedure involving incisions and underlying dissection, infection remains a possibility.

Signs of infection include increasing redness, warmth, swelling, and tenderness at or near the incision site, discharge or pus, fever, and chills. Any of these symptoms should prompt review by Dr Roth. When identified early, most infections respond well to antibiotic treatment. More extensive infection, or infection involving implanted fixation devices, may require surgical intervention including removal of the device.

Post-operative wound care instructions — including keeping incisions clean, avoiding submerging the scalp in water until incisions are healed, and gentle washing as directed — are designed to minimise infection risk. Patients should avoid touching or scratching incisions during healing.

Patients with diabetes, immunosuppression, or other conditions affecting immune function or healing are at higher risk of post-operative infection. These factors must be disclosed at consultation.

12. Pain — Including Persistent Pain

Some degree of discomfort and tension in the forehead and scalp is expected after a brow lift, particularly in the first few days. The forehead and scalp tissues are lifted under some degree of tension, and this, combined with the normal inflammatory response to surgery, contributes to initial discomfort. Pain is generally well managed with paracetamol and, where appropriate, prescribed analgesia.

Headache is common in the first week and is related to tension on the scalp tissues and the muscles of the forehead. In most patients, this resolves progressively as swelling subsides and tissues relax.

In a small number of patients, pain or discomfort in the forehead, temples, or scalp persists beyond the expected recovery period. Causes of persistent pain include:

• Nerve irritation or neuroma formation along the incision line or at fixation sites
• Ongoing tension in the elevated tissues
• Suture or fixation device irritation
• Scar sensitivity

Persistent post-operative pain should be reported to Dr Roth so that the cause can be investigated and appropriate management — which may include physiotherapy, targeted injections, or in some cases removal of fixation hardware — can be discussed.

13. Skin Loss

Skin loss — necrosis of the skin overlying the surgical site — is a rare but serious complication that can occur when the blood supply to a segment of skin is compromised during surgery. In brow lift procedures, skin loss is most likely in the vicinity of incisions, particularly if the tissues are closed under excessive tension, if haematoma or infection impairs perfusion, or if smoking significantly reduces blood supply to the healing wound.

Minor wound edge necrosis may heal with careful wound management, leaving a scar. More extensive skin loss may require skin grafting or other reconstructive procedures and can result in permanently visible scarring. The risk of skin loss is substantially increased in patients who smoke.

While skin loss is uncommon in primary brow lift surgery, it is higher in revision procedures where the normal vascular supply to the scalp has been altered by previous surgery. Careful surgical planning, conservative dissection, and tension-free wound closure minimise — but do not eliminate — this risk.

14. Scarring

All brow lift techniques involve incisions that will result in scars. The location and length of these scars varies by technique — from multiple small incisions within the hairline (endoscopic), to a continuous incision along or behind the hairline (trichophytic or coronal), to small temporal incisions, to incisions directly above the brows (direct approach). The surgical approach is selected in part to place incisions where scars are least visible.

For most patients, incision lines fade progressively over the months following surgery, ultimately becoming pale and difficult to detect within the hairline or scalp. However, scar quality varies between individuals and is influenced by genetics, skin type, tension on the wound during healing, and whether complications such as infection or haematoma occur.

Possible scar-related outcomes include:

• Hypertrophic (raised) scarring: The scar becomes raised, thickened, and red. This is uncommon in scalp incisions but can occur, particularly if healing is complicated. Treatment options include topical silicone, steroid injections, or laser treatment.
• Widened scar: If wound edges are closed under tension, or if healing is disrupted, the scar may widen. This is more relevant in coronal and trichophytic approaches where longer incisions are used.
• Visible scar at the hairline: In the trichophytic approach, if hair regrowth through the scar is incomplete, the scar may be visible along the hairline border. Hair regrowth through a trichophytic incision is not guaranteed.
• Scar-related alopecia: A strip of permanent hair loss along the incision line can result if follicles are damaged during incision or healing. This is distinct from the temporary hair shedding discussed in section 3.

Sun protection of healing incisions is important. Incisions should be protected from direct UV exposure during the healing period, and SPF50+ sunscreen used when outdoors.

15. Need for Revision Surgery

Despite careful planning and execution, a proportion of patients may not achieve their desired outcome from a primary brow lift, or may develop complications that require further surgical intervention. Reasons for revision may include unsatisfactory brow position, persistent or worsening asymmetry, complications with healing or scarring, suture or fixation device issues, or hair loss along the incision.

Revision brow lift surgery is generally more technically demanding than primary surgery. The normal tissue planes have been altered by the previous procedure, blood supply to the scalp may be less predictable, and the tissues may be less mobile due to scarring. The ability to achieve meaningful improvement through revision surgery depends on the nature of the problem, the technique used originally, and the degree of residual tissue mobility.

The possibility of revision surgery — and the realistic expectations for what further surgery can achieve — should be factored into a patient’s decision-making process from the outset.

Making an Informed Decision

The risks outlined on this page are not exhaustive — they represent the most significant and most commonly discussed complications of brow lift surgery, but other unexpected outcomes can occur. The decision to proceed should be made after careful reflection, and only after you have had the opportunity to discuss your specific circumstances, anatomy, goals, and concerns with Dr Roth in detail.

You are encouraged to take as much time as you need before deciding whether to proceed, to prepare a list of questions for your consultation, and to seek a second opinion if you wish. No reputable surgeon will pressure you to commit to surgery before you are ready.

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