Eyebrow Position Changes After Double Eyelid Surgery: Influence of Preoperative Compensatory Brow Elevation

Background: Postoperative eyebrow position change after double-eyelid surgery can affect aesthetic outcomes, but its mechanism remains unclear. This study aimed to investigate the influence of preoperative eyebrow elevation and other factors using the buried-suture technique to reduce confounding from tissue manipulation. Methods: This retrospective study analyzed patients who underwent buried-suture double-eyelid surgery performed by the senior author. Eyebrow height was measured pre- and postoperatively using standardized photographs, and changes were compared between groups stratified by preoperative eyebrow elevation. Subgroup analyses were also performed based on crease height, fixation method, sex, and laterality. Results: A total of 108 patients (216 eyelids) were included. The average rate of eyebrow position change across all patients was 4.8%. Patients with marked preoperative eyebrow elevation exhibited more pronounced postoperative eyebrow descent, and all such eyelids showed a downward shift. Subgroup analyses by crease height, fixation method, sex, and laterality revealed no significant differences in eyebrow-position change. Conclusions: Preoperative eyebrow elevation is a strong predictor of postoperative descent. This factor should be considered during surgical planning and patient counseling to improve accuracy in outcome prediction after double-eyelid surgery.