Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
The gliding brow lift is a specific surgical technique within the broader category of brow lift surgery. It uses small hairline incisions, subcutaneous tissue release, and a temporary external fixation system called the A-Net (hemostatic net) to reposition the brow. The technique is distinct from endoscopic, coronal, and lateral approaches in how the tissue is released, mobilised, and held in its new position during the early healing phase.
This guide focuses on the surgical details of the gliding approach. For general information on brow lift surgery, including all available techniques, recovery, costs, and consultation pathway, see the brow lift procedure page.
Looking for general brow lift information? Visit the main brow lift page for a full overview of all techniques (endoscopic, gliding, lateral temporal, coronal, pretrichial), recovery, cost, and the consultation process.
What Is a Gliding Brow Lift?
A gliding brow lift is a surgical technique that repositions the brow and forehead tissues through small hairline incisions using subcutaneous release rather than subgaleal or subperiosteal dissection. The released tissue is allowed to “glide” upward into its new position, and a temporary external suture pattern (the A-Net) is applied across the forehead to hold the position during the initial 5 to 7 days of healing.
The technique is one of several brow lift approaches Dr Turner performs. Selection between techniques depends on individual anatomy, the degree of brow descent, forehead height, hairline pattern, and whether other procedures are planned at the same operation. Technique selection is discussed at consultation, with the alternative approaches outlined on the brow lift procedure page.
Surgical Anatomy Relevant to the Gliding Approach
Three anatomical layers are relevant to the gliding brow lift:
- Skin and subcutaneous fat, the most superficial layer, containing fine cutaneous vessels and the supra-orbital and supratrochlear nerves as they emerge from the deeper tissue
- Frontalis muscle and galea aponeurotica, the muscular and aponeurotic layer responsible for brow elevation
- Loose areolar tissue (subgaleal plane), the deep plane between the galea and the periosteum, where most other brow lift techniques operate
The gliding technique works in the subcutaneous plane (between skin and frontalis). This is in contrast to endoscopic brow lift, which works in the subgaleal or subperiosteal plane.
The supra-orbital and supratrochlear neurovascular bundles emerge approximately 2.5 to 3 cm from the midline at the orbital rim. Knowledge of their position is essential for any forehead surgery, as injury produces forehead numbness or persistent neuropathic pain. The gliding plane stays superficial to these bundles for most of the dissection, reducing the risk of nerve injury compared to deeper plane techniques.
The Gliding Brow Lift Technique Step by Step
Incision Placement
Small incisions, typically 1.5 to 2 cm, are placed within the hairline. The exact placement depends on the hairline pattern and the planned vector of brow elevation. Usually two paramedian incisions and two lateral incisions are made, four in total.
Subcutaneous Plane Release
A blunt and sharp dissection is performed in the subcutaneous plane from each incision, fanning out across the forehead to release the soft tissue attachments. The dissection extends to the orbital rim laterally and to the supra-orbital ridge centrally. Care is taken to preserve the supra-orbital and supratrochlear neurovascular bundles.
Tissue Mobilisation
Once the subcutaneous release is complete, the brow and forehead skin can be advanced upward. The amount of advancement is assessed manually and is typically 5 to 10 mm at the brow. Asymmetric advancement may be planned where pre-operative analysis identifies asymmetric brow descent.
A-Net (Hemostatic Net) Fixation
The defining step of the gliding technique. A specific suture pattern using either nylon or polypropylene is applied across the forehead in a cross-hatched grid pattern. The sutures are placed through the skin into the deep tissue and tied externally over bolsters or directly on the skin. The pattern serves three purposes:
- Maintains the elevated tissue position during the early healing phase while the released soft tissue begins to re-adhere in its new location
- Provides hemostasis by compressing the subcutaneous space against the underlying tissue, reducing haematoma risk
- Distributes tension evenly across the forehead, avoiding focal pressure points
The A-Net is left in place for approximately 5 to 7 days and removed at the first post-operative visit.
Closure
The small hairline incisions are closed with absorbable deep sutures and either absorbable or removable skin sutures. No drain is required.
The Hemostatic Net Explained
The hemostatic net (A-Net) technique was originally developed for facelift surgery and has been adapted for use in gliding brow lift. The clinical purpose is to reduce the rate of haematoma and seroma by mechanically compressing the operative space, while simultaneously holding the elevated tissue in position.
The technique was published in detail by Auersvald and Auersvald in 2014 (Aesthetic Surgery Journal) and has since been adopted by surgeons across multiple facial procedures. In gliding brow lift specifically, the net provides what bone tunnels and screws provide in endoscopic technique: a means of holding the elevated brow position during initial healing.
The trade-off is visible suture marks across the forehead for the 5 to 7 day fixation period. These marks resolve completely once the net is removed and the small entry points heal.
How Gliding Brow Lift Differs From Endoscopic Brow Lift
The two techniques achieve a similar goal (brow elevation) through different anatomical planes and fixation methods. Key differences:
| Gliding Brow Lift | Endoscopic Brow Lift | |
|---|---|---|
| Plane of dissection | Subcutaneous (superficial to frontalis) | Subgaleal or subperiosteal (deep) |
| Visualisation | Blunt and sharp dissection without camera | Endoscope and video monitor |
| Number of incisions | 4 (typically) | 3 to 5 |
| Fixation method | External A-Net for 5 to 7 days | Internal bone tunnels or screws |
| Visible post-op fixation | Yes (sutures visible 5 to 7 days) | No (fixation hidden under scalp) |
| Neurovascular bundle risk | Lower (stays superficial) | Higher (works around bundles) |
| Combination with deep plane facelift | Less common | More common (shared plane) |
Neither technique is inherently superior. The choice depends on individual anatomy, surgeon assessment, and patient preference after detailed discussion. Comparison of all available techniques is covered on the brow lift procedure page.
How Gliding Brow Lift Differs From Coronal and Lateral Approaches
Coronal brow lift uses a single long incision across the top of the scalp, with subgaleal or subperiosteal dissection. It produces the most powerful elevation but involves a longer incision and elevates the hairline. The gliding approach uses multiple short hairline incisions and preserves hairline position.
Lateral or temporal brow lift addresses only the outer brow through a temporal hairline incision. It does not elevate the medial brow. The gliding technique elevates the entire brow more uniformly, including the medial portion.
Patient Selection Criteria
The gliding brow lift may be suitable for patients with:
- Mild to moderate brow descent affecting the medial and lateral brow
- Adequate skin elasticity to support repositioning without skin excision
- A hairline pattern that allows hidden hairline incisions
- Acceptance of the 5 to 7 day external A-Net fixation period
- No prior brow lift surgery
- General good health and non-smoking status
Patients who may not be suitable for the gliding approach include those with:
- Severe brow descent or significant forehead furrows requiring stronger elevation (consider coronal)
- Very thin or fragile skin where A-Net suture marks may persist
- Inability to tolerate the visible fixation period
- Previous extensive forehead surgery altering tissue planes
- Active dermatological conditions affecting the forehead
Final candidacy assessment is conducted at consultation. Where the gliding technique is not the right approach, alternative brow lift techniques are discussed. The full consultation pathway is outlined on the brow lift procedure page.
Combined Procedures
The gliding brow lift can be combined with other facial procedures at the same operation, most commonly upper blepharoplasty when both brow descent and upper eyelid skin excess are present. The brow lift is performed first so any upper blepharoplasty addresses the residual eyelid skin after the brow has been elevated.
Combination with facelift, deep plane facelift, or fat grafting may also be appropriate depending on overall facial assessment.
Risks Specific to the Gliding Technique
In addition to the general risks of brow lift surgery, the gliding approach has specific considerations:
- A-Net suture marks, temporary skin marks at suture entry points, present during the 5 to 7 day fixation period
- Subcutaneous haematoma, reduced by the net but not eliminated
- Skin dimpling, uncommon, may resolve over weeks
- Recurrence of brow descent, possible if soft tissue re-adheres to its original position before remodeling completes; the A-Net is designed to reduce this risk
General brow lift risks (bruising, swelling, scalp numbness, asymmetry, hairline change, hair loss around incisions, frontal nerve injury, bleeding, infection, anaesthetic reaction) are discussed in detail at consultation.
What the Research Says
Published surgical literature on the gliding brow lift technique is more limited than on endoscopic brow lift but includes the following:
- Auersvald and Auersvald (Aesthetic Surgery Journal, 2014) on the hemostatic net technique in face surgery, which underlies the A-Net application in gliding brow lift
- Reports of subcutaneous brow lift techniques predating the gliding nomenclature, with similar anatomical principles
- Comparative case series showing acceptable revision and complication rates compared to endoscopic technique in selected patient populations
The technique is appropriate for the right patient population but is not a universal replacement for endoscopic or coronal approaches.
Frequently Asked Questions
What is a gliding brow lift?
A gliding brow lift is a surgical brow elevation technique using small hairline incisions, subcutaneous tissue release, and temporary external fixation with an A-Net (hemostatic net). It allows the brow and forehead tissue to be advanced upward and held in position for the initial 5 to 7 days of healing. The technique is one of several brow lift approaches and is appropriate for selected patients with mild to moderate brow descent.
How is a gliding brow lift different from an endoscopic brow lift?
The two techniques work in different anatomical planes. Gliding brow lift works in the subcutaneous plane (between skin and frontalis muscle) and uses external A-Net fixation. Endoscopic brow lift works in the subgaleal or subperiosteal plane (under the muscle, against the skull) and uses internal bone tunnel or screw fixation. The gliding approach has visible suture marks for 5 to 7 days; endoscopic fixation is hidden. Selection depends on individual anatomy and surgeon assessment.
What is the A-Net or hemostatic net in a gliding brow lift?
The A-Net is a specific suture pattern applied across the forehead skin in a cross-hatched grid. It uses nylon or polypropylene sutures placed through the skin into the deep tissue, tied externally. The net holds the elevated brow position, distributes tension evenly, and compresses the operative space to reduce haematoma risk. It is left in place for 5 to 7 days and removed at the first post-operative visit.
Can a gliding brow lift be combined with upper blepharoplasty?
Yes. Gliding brow lift is commonly combined with upper blepharoplasty when both brow descent and upper eyelid skin excess are present. The brow lift is performed first so the upper blepharoplasty addresses the residual eyelid skin after the brow has been repositioned. Performing blepharoplasty alone without addressing brow descent may produce a tight or unnatural appearance where brow descent is the main cause of upper face heaviness.
What are the risks specific to the gliding brow lift technique?
In addition to general brow lift risks (bruising, swelling, scalp numbness, asymmetry, hair loss around incisions, nerve injury, infection), the gliding technique has specific considerations: visible A-Net suture marks during the 5 to 7 day fixation period, possible skin dimpling, and recurrence of brow descent if soft tissue adhesion patterns favour the original position. All risks are discussed in detail at consultation.
Consult with Dr Scott J Turner
The right brow lift technique depends on individual anatomy, brow position, forehead height, hairline pattern, and the broader facial assessment. The gliding brow lift is one option among several, and is not always the right approach for every patient.
For a detailed consultation covering all available brow lift techniques and which approach suits your anatomy, contact the practice. The full consultation pathway, including the AHPRA-required GP referral, two consultations, psychological screening, and cooling-off period, is outlined on the brow lift procedure page.
Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) consulting at Bondi Junction and Manly in Sydney.
