Difference Between a Sub-Brow Lift (Sub-Brow Incision) and Upper Blepharoplasty: Where to Make the Incision for Sagging Eyelids

A sub-brow lift (sub-brow incision) is a surgery that removes sagging eyelid skin through an incision made right beneath the eyebrow, and is considered when you want to correct sagging while keeping your current eye shape and double eyelid line intact. For sagging eyelid surgery, the incision location varies depending on the distance between the eyebrows and eyes, and whether you desire a double eyelid.

As we age, the elasticity of the orbicularis oculi muscle—the muscle used to close the eyes—decreases, causing the skin and fat around the eyes to sag together. When drooping eyelid skin descends over the eyelashes, the eyes can look smaller or sleepy, existing double eyelids may be obscured, and in severe cases, vision can even be blocked. While people often think of upper blepharoplasty—making an incision in the eyelid—to correct this drooping, there are also surgical methods that involve incising below or above the eyebrow. Here is an overview of how these three surgeries differ, which eyelids are suitable for a sub-brow lift, and what is evaluated during a consultation.

AI-generated image for illustrative purposes.

There are three types of sagging eyelid surgery depending on the incision location

Surgeries that remove sagging eyelid skin are categorized into upper blepharoplasty, sub-brow lift, and supra-brow lift depending on where the incision is made. While all three procedures share the goal of removing excess skin, they differ in the placement of the incision line and how the double eyelid line is addressed.

Three surgical options categorized by incision location. From left: upper blepharoplasty with an incision along the eyelid, sub-brow lift with an incision right below the eyebrow, and supra-brow lift with an incision right above the eyebrow; the red areas indicate the excised tissue.

• Upper Blepharoplasty — Incising the eyelid to remove skin, muscle, and fat according to its condition, and creating a double eyelid line if needed (Upper Blepharoplasty)
• Sub-Brow Lift — Incising right below the eyebrow to remove sagging skin and muscle, then lifting and securing the skin (Sub-Brow Lift)
• Supra-Brow Lift — Incising right above the eyebrow to remove skin and muscle, then lifting and suturing the skin, simultaneously correcting sagging eyebrows depending on the condition (Supra-Brow Lift)

Here is the key point — For sagging eyelids, determining where to make the incision comes first, and the criteria are the distance between the eyebrows and eyes and what to do with the double eyelid.

The distance between the eyebrows and eyes and the double eyelid are the primary criteria

Which surgery to consider is determined by evaluating the distance between the eyebrows and eyes, whether the eyebrows are also sagging, and how the double eyelid line should be addressed.

Two eyes with the same degree of sagging eyelid skin but different eyebrow positions. The left shows an eye with a wide distance between the eyebrow and eye, while the right shows a low eyebrow with a narrow distance. This is an AI-generated image for illustrative purposes.

• When the distance between the eyebrow and eye is wide and sagging is severe — Consider a sub-brow lift. It refines sagging eyelids and the outer corners of the eyes while leaving your current eye shape and double eyelids intact.
• When the distance between the eyebrow and eye is narrow or the eyebrows also sag — Consider a supra-brow lift. It lifts sagging eyelids while maintaining the distance between the eyes and eyebrows.
• The double eyelid line lost as the eyelid sagged — Consider upper blepharoplasty. It removes sagging skin and recreates the double eyelid line if necessary.

A sub-brow lift removes sagging skin right below the eyebrow

A sub-brow lift is a surgery that removes sagging eyelid skin through an incision made right beneath the eyebrow. No incision is made along the double eyelid line. Therefore, it refines sagging eyelids and the outer corners of the eyes while preserving your current eye shape and double eyelid line.

At APEX Plastic Surgery, a sub-brow lift involves designing the incision line tailored to individual symptoms, making an incision closely beneath the eyebrow, removing sagging skin, and suturing with fine thread.

The sub-brow lift procedure. From left: sub-brow incision design, incision below the eyebrow, removal of sagging skin, and suturing; this may vary depending on the individual.

• Method — Incising right below the eyebrow to remove sagging skin and muscle, lifting and securing the skin, and then suturing
• Eyelids considered — Eyes with a wide distance between the eyebrow and eye and significant eyelid sagging; wishing to maintain the existing double eyelid line or eye shape; sagging eyelids without double eyelids; looking sleepy due to eyelid sagging
• Points to note — The incision line remains at the lower border of the eyebrow. It is not a procedure to create a new double eyelid line. If the distance between the eyebrow and eye is narrow or the eyebrows also sag, other methods should be considered

Also considered when eyelids are thick and appear heavy

Sagging eyelids are not solely a concern for middle age and beyond. A sub-brow lift may also be considered for people in their 20s and 30s whose eyes still appear heavy even after fat removal, or for those in their 50s and beyond with thick eyelid skin. A sub-brow lift is also an effective way to thin out the eyelids by removing sagging skin from below the eyebrows.

It is also considered when you have monolids but do not want double eyelid surgery, or when you have subtle inner double eyelids that are slightly covered by skin. If you also desire a double eyelid line, combining a sub-brow lift to remove excess skin with a non-incisional (suture) method instead of an incisional double eyelid surgery can be considered. The criteria for choosing a double eyelid surgery method were covered in the Double Eyelid Surgery Methods Column.

APEX Plastic Surgery's Sub-Brow Lift·Upper Blepharoplasty·Supra-Brow Lift standards. The actual method is determined after an examination.

Please keep in mind — Complications such as bleeding, infection, inflammation, scarring, asymmetry, and reduced sensation around the eyebrows may occur after surgery. The incision line remains beneath the eyebrow, and the visibility of the scar varies depending on skin condition and other factors. Swelling, bruising, the recovery process, and progress vary from person to person. Specific precautions will be explained in detail during your consultation.

Preoperative consultation comes first

“In facial plastic surgery such as on the eyes or nose, recovering from postoperative side effects requires considerable time and cost, so it is essential to consult with a board-certified specialist at a verified medical institution before undergoing any procedure.” — Song Hyun-seok, Lead Director

Frequently Asked Questions

Does a sub-brow lift create a double eyelid?

Because a sub-brow lift is a surgery that removes skin from below the eyebrow, it does not create a new double eyelid line. Any existing double eyelid line is left intact.

If you also want a double eyelid line, you can consider combining it with a non-incisional method, or opt for upper blepharoplasty, which incises the eyelid.

Where does the scar remain?

Because the incision is placed closely along the base of the eyebrow, the incision line remains along the lower border of the eyebrow. The visibility of the scar and the time it takes to settle vary depending on skin condition and other factors.

Which is better, upper blepharoplasty or a sub-brow lift?

Rather than one being superior to the other, the appropriate method depends on the distance between the eyebrows and eyes and what you wish to do with your double eyelids. If the distance between your eyebrows and eyes is wide and you wish to keep your current double eyelids, a sub-brow lift is recommended; if your double eyelids have loosened or you want to create a new line, upper blepharoplasty is considered.

Are sleepy-looking eyes always caused by sagging eyelids?

It may be due to sagging skin, but it could also be due to ptosis, where the eyelid does not lift sufficiently because the eye-opening power is weak. During consultation, we check whether ptosis is also present.

The difference between sagging skin and ptosis is covered in our Ptosis Correction Column.

What are the surgery duration and recovery period?

At APEX Plastic Surgery, a sub-brow lift takes about 1 hour under local anesthesia or IV sedation, requires no hospitalization, stitch removal occurs after 5 days, involves 1–2 follow-up visits, and has a recovery period of about 5–7 days. The same criteria apply to upper blepharoplasty and supra-brow lifts.

This may vary depending on the patient's condition and surgical technique.

For sagging eyelids, the incision location is determined first

What we examine first during consultation

• Eyelid sagging — Degree of sagging and wrinkles, drooping at the outer corners
• Between brow and eye — Distance, and whether the eyebrows have also sagged
• Double Eyelid — Whether to keep the current line or create a new one
• Skin and hollowing — Skin type and thickness, and whether the eyelid is hollowed
• Eyelid-lifting strength — Whether ptosis is also present
• Facial harmony — Whether the eye shape harmonizes with the overall facial impression

These are the eyelid conditions evaluated together during consultation. From the left: eyelid sagging and wrinkles, eyelid hollowing, and ptosis.

At APEX Plastic Surgery, board-certified plastic surgeon Dr. Song Hyun-seok provides all consultations and treatments.

Song Hyun-seok, Head Director · Board-Certified Plastic Surgeon, Ph.D.

This article is intended to provide medical information, does not guarantee specific treatment outcomes, and does not replace consultation with a physician. The featured image and the eyebrow position comparison illustration are AI-generated images to aid understanding and do not depict real persons, and the remaining eye drawings are also explanatory illustrations. None of the images in this article are before-and-after comparison photos. Details such as surgery duration, anesthesia, and recovery period are based on the surgical guidelines on the APEX Plastic Surgery website and may vary depending on the individual. Potential post-operative complications such as bleeding, infection, and inflammation may vary in severity depending on the individual, so caution is advised. Please ensure you receive a thorough consultation, detailed explanation, and provide informed consent prior to surgery.