The indirect brow lift has been associated with the mid-forehead lift by some researchers, and others have called it the mid-forehead brow lift (5,12). It is essentially the same procedure as the direct brow lift, but the skin excision is performed bilaterally at some distance above the eyebrow in the forehead. The indirect brow lift is indicated in patients with marked or asymmetric brow ptosis and forehead furrows and those in whom a coronal forehead lift is contraindicated. The patient's skin type must be satisfactory, and the patient must be advised fully about the resultant scar. Men who have male pattern baldness or women who have thin and light hair with a high hairline are potential candidates.
Advantages of the indirect lift include its ability to conceal the forehead incision within a skin crease and at the same time achieve a relatively proximal suspension for the eyebrow, thus leading to a long-lasting and precise elevation. Depending on the location and extent of the skin excision, the shape of the brow also can be configured as desired. Disadvantages include its relatively selective use. It may be indicated in patients who have significant rhytids and skin that will heal well and who are not candidates for a coronal forehead lift.