Why Do Eyebrows Sag Lower as We Age? - A Forehead Lift May Be the Solution.

Hello.

I am Huh Jae-won, a board-certified plastic surgeon at 입체성형외과, where I perform rejuvenation surgery.

If you often hear that you look tired, or if your eyes seem smaller than before, the cause may be surprisingly simple.

It is the change in eyebrow position. As time passes, eyebrows slowly descend, and this becomes more than just a cosmetic issue—it is a key factor that shapes the overall impression of the face.

When the eyebrows move lower than their original position, the double-eyelid line becomes covered, the area around the eyes looks heavier, and the face gives a generally gloomy impression.

These changes are not simply a sign of aging, but an anatomical issue caused by structural changes inside the forehead.

But why do eyebrows sag lower as we age?

The answer lies in the mechanical relationship of the forehead muscles.

There is only one muscle that lifts the eyebrows upward: the frontalis.

In contrast, there are as many as four muscles that pull the eyebrows downward.

• depressor supercilii

• procerus

• corrugator supercilii

• orbicularis oculi

And when gravity—the most powerful and persistent force on Earth—is added to that, an unfair 1-to-5 battle begins!

As time passes, this imbalance worsens, and the eyebrows are gradually pushed downward below the superior orbital rim.

In particular, when the eyebrows sit below the border of the orbital bone, they compress the upper eyelid area, cover the double eyelid, and make the eyes look smaller and more constrained.

If only upper eyelid surgery is performed in this situation?

The root cause remains unresolved, and the vicious cycle of the eyebrows sagging even lower may continue.

A Revolutionary Change Brought by Endoscopic Techniques

In the past, forehead lift surgery was mainly performed through a coronal incision, a long incision made along the hairline.

However, this method had problems such as large scars, a long recovery period, and side effects like reduced sensation.

Endoscopic forehead lift surgery is an innovative approach that overcomes these limitations.

With just 3 to 5 small incisions of 1–2 cm inside the hairline, the entire forehead can be accessed. The procedure is performed while using an endoscope to identify the anatomical structures in real time. This completely eliminates the old blind approach that depended on guesswork and makes precise and safe surgery possible.

The most important part of endoscopic surgery is accurately understanding the complex structures inside the forehead.

The supratrochlear nerve and supraorbital nerve exit the orbit at points 1.5 cm and 2.5 cm from the midline, respectively, so careful attention is needed to avoid injuring them.

In addition, important structures such as the thick periosteal attachment called the temporal fusion line and the frontal branch of the facial nerve are intricately involved. With the help of the endoscope

these structures can be visually confirmed, so the areas that need to be cut are cut clearly, and the areas that need to be preserved are left intact. As a result, the risk of nerve injury has been greatly reduced.

Why is it more important to ask "Why did it come down?" than "How far should it be lifted?"

The various problems caused by descended eyebrows—forehead wrinkles, pressure on the eyelids, and changes in facial impression—ultimately begin with changes in the entire anatomy of the forehead.

That is why understanding "why it came down" first, rather than "how far to lift it," is the starting point of treatment.

Because this is not a problem on the skin surface but a problem in the internal structure of the forehead, the method that can address it accurately is endoscopic forehead lift surgery.

In the next part, I will explain the actual surgical process step by step and show the remarkable improvement that endoscopic forehead lift surgery can bring through a real case of a patient in their 60s. I will also carefully cover who is suitable for this surgery, what the recovery process is like, and whether there are any side effects.

If you feel that your eyebrows have dropped lower than before, or that your upper eyelids have become heavier and your expression more constrained, it may be good to read Part 2 as well.

Thank you. This has been Huh Jae-won, board-certified plastic surgeon.