One area of controversy is treatment of the Asian brow. Some surgeons suggest that a flatter forehead bone favors earlier descent of the upper third of the Asian face and may account for signs of fullness in the upper eyelid.

A few go so far as to aggressively advocate brow lift (another name for forehead lift, or upper facelift) at a questionably young age, sometimes as early as the late twenties.

Other surgeons feel that unless brow position is clearly too low (often associated with the appearance of frowning or sadness), recommending a forehead lift is a misguided way of avoiding having to perform upper eyelid surgery, a more delicate and precise operation.

Pulling the brow upward will indeed mechanically lift the thin eyelid skin; however, facial appearance taken as a whole may look obvious and unnaturally arched after inappropriate upper facelift.

The brows may be lifted using any of the standard methods, including the full coronal (ear to ear) incision, the endoscopic approach from within the scalp, or from a direct incision placed just above or sometimes just below the brow hair.

A mild but often adequate lifting effect on the outermost brow can also be achieved by injecting BOTOX ® Cosmetic (BOTOX brow lift) just below the tail of the brow. Younger patients may find this a more acceptable alternative to surgical upper face lift.