Key Takeaways
- The gliding brow lift releases the forehead in the subcutaneous plane, between the skin and the frontalis muscle, rather than endoscopic or traditional coronal techniques.
- A temporary external net of sutures holds the brow position and is removed around three to five days after surgery.
- The trade-off is visible suture marks across the forehead that fade over a few weeks.
- It is one technique among several. Brow descent, forehead height, hairline pattern and skin quality guide the choice, not surgeon preference.
A gliding brow lift raises the brow through four small incisions inside the hairline, releasing the forehead skin in the subcutaneous plane, between the skin and the frontalis muscle. A temporary external net of sutures holds the new position for about three to five days while early healing takes place.
This is a technical guide to one technique. For suitability, recovery, fees and the consultation pathway across every approach, the brow lift procedure page is the better starting point, and the brow lift techniques guide compares the main approaches side by side.
Surgical anatomy
Three layers matter for this technique:
- Skin and subcutaneous fat. This layer contains fine cutaneous vessels and the supra-orbital and supratrochlear nerves as they emerge.
- Frontalis muscle and galea aponeurotica. This is the layer responsible for brow elevation.
- Loose areolar tissue in the subgaleal plane. Most other brow lift techniques operate here.
The gliding technique works in the first of these, superficial to frontalis. Endoscopic brow lift works in the third.
The supra-orbital and supratrochlear neurovascular bundles emerge roughly 2.5 to 3 cm from the midline at the orbital rim. Injury can cause forehead numbness or persistent nerve-related pain, so their position guides the dissection. Because the gliding plane stays superficial to these bundles, they are normally protected, compared with deep dissection techniques.
How the gliding technique is performed
Incisions. Four small incisions, typically less than 1 cm, are placed within the hairline, usually two paramedian and two lateral. Placement follows the hairline pattern and the planned direction of lift.
Subcutaneous release. Blunt and sharp dissection fans out across the forehead from each incision. Soft tissue attachments are released at the orbital rim laterally and the supra-orbital ridge centrally, while the neurovascular bundles are preserved.
Mobilisation. Once released, the brow and forehead skin advance upward, typically by 5 to 10 mm at the brow. Where pre-operative assessment shows the two brows have descended unevenly, which is common, the advancement can be planned to differ between sides.
Net fixation. A cross-hatched grid of nylon or polypropylene suture is passed through the skin into deep tissue and tied externally. The net stays in place for around three to five days after surgery and is then removed.
Closure. Absorbable deep sutures are used, with either absorbable or removable skin sutures. No drain is placed.
The hemostatic net and why it is used
The hemostatic net was developed for facelift surgery. André and Luiz Auersvald described it in Aesthetic Plastic Surgery in 2014, in a series of 405 consecutive facelift patients, as a way to reduce the risk of haematoma. Colleagues named it the A-Net after its authors. It has since been adapted for other facial procedures, so its use in brow surgery extends the original evidence rather than being directly tested by it.
In a gliding brow lift the net has three roles. It holds the elevated tissue while the released soft tissue begins to re-adhere in its new position, it compresses the subcutaneous space to reduce the risk of haematoma, and it spreads tension evenly rather than concentrating it at single points.
It does the job that bone tunnels or screws do in an endoscopic brow lift. The difference is that the fixation sits outside the skin, which is why it is temporary and briefly visible.
How it compares with other brow lift techniques
| Gliding | Endoscopic | |
|---|---|---|
| Plane of dissection | Subcutaneous | Subgaleal or subperiosteal |
| Visualisation | Direct dissection | Endoscope and monitor |
| Incisions | Usually four | Three to five |
| Fixation | External net, around three to five days | Internal bone tunnels, screws or sutures |
| Fixation visible after surgery | Yes, for around three to five days | No |
Neither approach is inherently superior. The endoscopic brow lift guide explains that technique in detail.
Coronal brow lift uses a single long incision across the scalp, with dissection in a deeper plane. It allows a greater degree of elevation, but it involves a longer scar and can raise the hairline. The gliding approach does not advance the scalp in the same way, so hairline position is not expected to change.
Lateral or temporal brow lift acts on the outer brow only, through an incision in the temporal hairline. It does not lift the medial brow. Where the tail of the brow has descended and the inner brow sits where it should, it is the more proportionate operation.
Who may be suitable
A gliding approach may suit people with mild to moderate descent affecting both the inner and outer brow, adequate skin elasticity, a hairline pattern that allows the incisions to be concealed, and willingness to accept a period of visible fixation.
It may be less suitable where there is severe descent or deep forehead furrows that call for a stronger lift, very thin or fragile skin where suture marks might persist, previous extensive forehead surgery that has altered the tissue planes, or an inability to manage three to five days of visible fixation. Suitability is decided at consultation, not from a photograph.
Combining a brow lift with upper eyelid surgery
A gliding brow lift is often considered alongside upper blepharoplasty when both brow descent and upper eyelid skin excess are present. Sequence matters. The brow position is set first, and any eyelid skin is then assessed against its new position, because removing eyelid skin first risks removing too much once the brow has been raised. The brow lift vs blepharoplasty guide explains how to tell which structure is responsible for heavy upper eyelids.
Risks, limitations and uncertainty
The general risks of brow lift surgery include bruising, swelling, scalp numbness, asymmetry, hair loss around the incisions, injury to the nerve that moves the forehead, bleeding and infection. The gliding approach also carries some specific considerations:
- Suture marks at the net entry points during the fixation period.
- Subcutaneous haematoma, which the net reduces but does not eliminate.
- Skin dimpling, which is uncommon and usually resolves over weeks.
- Recurrence of descent, where soft tissue drifts back toward its original position before remodelling is complete.
The evidence base is limited. Most published work on brow lift techniques consists of case series from individual surgeons, with few direct comparisons between approaches, so no technique can be shown to last longer or look more natural than another. Individual results vary, no outcome can be guaranteed, and further surgery may be needed. Recovery across techniques is covered in the brow lift recovery guide.
Before surgery is booked
In Dr Scott J Turner’s practice the main brow operation is the endoscopic lateral brow lift. A gliding approach is used in selected cases, most often where the two brows sit at different heights or where a minor revision of an earlier brow lift is needed. Technique selection is made at consultation. The training and credentials of Dr Scott J Turner, Specialist Plastic Surgeon (FRACS), are set out on his surgeon profile. Surgery requires a referral from a registered medical practitioner (a GP referral is acceptable), at least two pre-operative consultations, the first of which may be by video and the second in person, and a cooling-off period of at least seven days before surgery can be booked. To arrange a consultation, contact the practice.
Frequently asked questions
What is a gliding brow lift?
A gliding brow lift is a surgical technique that raises the brow through small incisions inside the hairline. The forehead skin is released in the subcutaneous plane, between the skin and the frontalis muscle, and then advanced upward. A temporary external net of sutures holds the position for around three to five days. Suitability and results vary between individuals.
How does a gliding brow lift differ from an endoscopic brow lift?
The two differ in the plane of dissection and in the way the brow is held. A gliding brow lift works between the skin and the frontalis muscle and uses an external net that is visible for around three to five days. An endoscopic brow lift works beneath the muscle with camera guidance and uses fixation that cannot be seen from the outside.
What is the A-Net?
The A-Net is a cross-hatched grid of sutures applied across the forehead and tied externally. It holds the brow in its new position, spreads tension evenly and compresses the operative space to reduce the risk of haematoma. It was first described for facelift surgery and is removed around three to five days after surgery. The suture marks it leaves are expected to resolve.
Can a gliding brow lift be combined with upper eyelid surgery?
Yes, the two are often considered together when brow descent and upper eyelid skin excess are both present. The brow position is set first so that eyelid skin can be assessed against its new position. Removing eyelid skin first risks removing too much once the brow has been raised. Whether both operations are needed is decided at consultation.
Is one brow lift technique better than the others?
No technique has been shown to be better for everyone. Brow descent, forehead height, hairline pattern, skin quality and any other surgery planned at the same time guide the choice. Each approach has its own scars, recovery and risks. The published comparisons between techniques are limited, so selection rests on the individual’s anatomy and on a discussion at consultation.
