Similar to facial or neck sagging, the forehead and eyebrow over time begin to lose elasticity and begin to lower down over the eyes. Many patients are told they look “angry” or “concerned” as hooding of the brow occurs. When looking in a mirror, you may notice that instead of the arch you once had, the outer part of the eyebrow has dropped to a lower position. This may cause bunching of the eyelid skin as well.
“Do I need a blepharoplasty (eyelid surgery) or a browlift?”
This is a great question. Many patients think they simply have excess skin over the eyes, when in fact, their low brow position is actually causing that bunching of skin. This is something that I evaluate on a case by case basis.
The Ideal Brow Position
The natural brow position for a woman and a man, are DIFFERENT. An arched brow may be a pleasant feature on a female patient, but may be a feminizing look on a male patient. The brow starts in the middle at the level of the bony orbital rim (the most pronounced part of the skull right above the eyeball). It continues out to the side of the face traveling along the orbital rim in men, and traveling slightly above the rim in women. In female patients, there is a small peak of the brow just outside of the iris (colored part of the eyeball) before coming back down to the orbital rim. In male patients, the brow stays relatively flat.
There are Different Methods to Deal with the Sagging Brow
1. Botox – In the right patient, there can be a slight lifting of the outside of the brow by placing botox in certain areas of the forehead. If it is placed above the sagging brow, however, the opposite effect would occur, and brow sagging would actually be much WORSE. Therefore having experience with this technique is very important. See my Botox Page for more information.
2. Injectables – Certain fillers can be used along the orbital rim (see image) which can give the appearance of a lifted brow. The brow itself is minimally moved, but the shadowing under the eyebrow is decreased and provides this effect. Most injectables last 1-2 years and more information can be found on my Injectable Page for all uses, indications, and expected results.
3. Endoscopic Brow Lift – Using a small camera and four small incisions (less than 1 inch each), the brow is gently separated from the tissues and elevated to a new position. This is held into place with either small screws (which are later removed in the office) or endotines (absorbable fixation devices under the skin). See my Brow Lift page for more information on surgical brow lift options.
4. Temporal (Lateral Brow) Lift – Through an incision hidden in the hairline, a lift of the brow can be performed. A similar lift to the endoscopic brow lift is performed, but with excision of excess skin. The removed skin allows tightening of and wrinkle removal of the side of the brow. See my Brow Lift page for more information on surgical brow lift options.
5. Forehead (Middle and Lateral Brow) Lift – Through an incision, either along the front of the hairline or behind the hairline, the entire forehead is lifted. This allows removal of the weight present in the middle brow, or glabellar, region. This procedure can also be performed with division of the corrugator muscles which cause frown lines. This can prevent frown lines in a more permanent fashion and avoid future Botox injections. See my Brow Lift page for more information on surgical brow lift options.