With the traditional open approach, an incision is made in the scalp, starting just above one ear, extending over the top of the head to the top of the other ear. The skin and muscle is then peeled down to the brow level where the brow and forehead muscles are partially removed. The skin flap is then pulled backwards, excess scalp skin is removed and the incision is closed in layers. Obviously, this leaves a scar across the top of the head, virtually excluding this as a procedure for balding men where the scar would be easily viewed.
Direct brow lifts are often performed by ophthalmologists where an ellipse of skin is removed from just above the eyebrow allowing it to elevate as the skin layers are closed. Although this directly elevates the brow, it does nothing for frown lines or forehead lines and can leave an obvious scar above each eyebrow. In general this should only be done as a minimal procedure in a patient who does not want or is not a candidate for a formal brow lift and in whom has lines in that area to hide the scars. In a similar fashion, inadvertent elevation of the brow can occur when skin is removed from the lower forehead to excise a skin cancer in that area creating an obvious brow asymmetry. To prevent this, local skin flaps can be used, preserving as much skin as possible and avoiding unwanted brow elevation.
Brow Lift/Facelift Combination
Also read "The Term 'Facelift' is a Misnomer"
Combining a brow lift with a facelift in the same setting is quite common. When this is done using the endoscopic technique, the lateral short endoscopic incisions are combined with the upper extension of the facelift incisions so that there aren’t two in the same area. The incisions for both the brow lift and the facelift are generally well back of the hairline and, therefore, remain well hidden. When only a lateral brow elevation is indicated, this can be accomplished by using only an extension of the facelift temporal incisions without the other endoscopic incisions, however, a more limited brow elevation is generally accomplished.