Temporal vs Pretrichial Brow Lift: My Approach in Austin
If you’ve been researching facelifts, you’ve probably noticed that some surgeons pair a deep plane facelift with a small temporal brow lift, while others perform a full brow lift. Both camps have their reasons.
In my Austin practice, I usually combine a deep plane facelift with a pretrichial brow lift. Here’s why, and when a temporal lift alone might be enough.
Why Brow Lifts Come Up With Facelifts
In a deep plane facelift, the incision runs around the ear, behind the tragus (the small flap of cartilage in front of the ear canal), and back along the hairline. Through that incision, I work at a deeper level and release the ligaments holding the face down.
The lift is strong. So strong that it can cause a little skin bunching at the outer corner of the eye and temple. You can test this at home. Gently lift your cheek skin up and back in the mirror and look at the corners near your eyes. If the skin bunches there, you probably need at least a temporal brow lift to smooth it out.
What a Temporal Brow Lift Is
The temporal brow lift partly grew out of facelift closure. To avoid little puckers of skin, called dog ears, at the top of the incision, surgeons extend it higher into the temporal hairline. The further you chase that extra skin, the more you end up raising the tail of the brow. That’s essentially a temporal brow lift.
Some surgeons say a temporal lift is all most people need. I think part of the reason is that endoscopic brow lifts often don’t give a great result in their hands.
My View on Endoscopic Brow Lifts
When I used to do endoscopic brow lifts, I found the results a bit lackluster for the amount of work involved. Visualization is limited. It’s hard to release all the ligaments holding the brows down, so you have to rely on Endotines or sutures to hold the brows up. In many before and after photos I’ve seen, things gradually relax back down.
To be fair, the research is mixed. A 2026 study in The Laryngoscope compared endoscopic and pretrichial brow lifts at one institution. Endoscopic lifts showed more elevation early on, and long-term brow height and complication rates were similar between the two. The authors concluded that hairline position and forehead length should guide the choice. A 10-year review of the endoscopic temporal brow lift in Plastic and Reconstructive Surgery reported effective elevation of both the inner and outer brow with few complications. Interestingly, those authors also noted that the endoscopic brow lift on its own has a reputation for recurrence, which is why they combined it with a temporal approach.
So endoscopic approaches can work well for some surgeons and some patients. My preference comes from what I’ve seen in my own hands, and from the kind of lift I want to give women who are already having a facelift.
Why I Prefer a Pretrichial Brow Lift
A pretrichial brow lift uses an incision along the front of the hairline. Through it, I can release every structure holding the brow down:
- The fascia along the temporal line
- The fascia around the orbital rim
- The attachments holding the central brow and forehead
It’s similar in principle to a deep plane facelift. Once things are released, I can rotate the outer brow up and over, rather than only pulling straight up.
Why the Inner Brow Matters
If you lift only the outer brow and leave the inner brow low, the face can look harsh, a bit masculine, and honestly a little angry. Some people like that look, and some are fine with a small lateral lift. Most women at facelift age need a balanced lift across the whole brow.
My post on how to get a natural brow lift result shows what I mean by balanced.
A Simpler Facelift Closure
There’s a practical benefit too. When I do the brow lift first, the extra temporal skin has already been addressed. I don’t need to extend the facelift incision as far up into the hairline.
How the Pretrichial Incision Heals
This is the question I get most. Most of the time, a pretrichial brow lift isn’t combined with hairline lowering, so the incision isn’t under as much tension. It heals well and quickly.
What to expect:
- Pinkness for several months. Even at one month, I often see small hairs growing through the incision.
- Numbness of the forehead and scalp for a while. Sensation returns as the pink fades, usually around three to six months.
- Possible temporary hair thinning near the incision.
To help with that last one, I place platelet-rich fibrin (PRF) in the pretrichial incision and in the facelift incisions. It forms a matrix under the incision that delivers growth factors, helps it heal faster, and encourages hair follicles not to go dormant.
For more on where these scars sit, read where are brow lift scars located.
Frequently Asked Questions
Do I need a brow lift with my facelift?
Not always. If the skin bunches at the outer corner of your eyes when you lift your cheeks, you likely need at least a temporal lift. A full evaluation will tell us whether the whole brow needs support.
Is a pretrichial brow lift scar noticeable?
It stays pink for a few months, then fades. Hair often grows through it, which helps hide it.
Does a pretrichial brow lift raise the hairline?
The incision is placed at the hairline, so it’s designed to avoid raising it. If your forehead is long, we may discuss combining it with hairline lowering.
Can a temporal brow lift make me look angry?
A lift that raises only the outer brow while the inner brow stays low can look harsh. Balance across the brow avoids that.
In my hands, a pretrichial brow lift with a deep plane facelift gives the most balanced, feminine result. If you’re comparing surgeons, ask how they handle the inner brow as well as the tail. You can read more about brow lift surgery in Austin, or schedule a consultation at my office toward Dripping Springs and we’ll look at your brows together. A virtual visit is a fine place to start.
You May Also Like:
- Where Are Brow Lift Scars Located?
- How to Get a Natural Brow Lift Result
- The Real Reason You Have Hooded Eyes
- Deep Plane vs SMAS Facelift
- Brow Lift Gallery
