One of the classic signs of early facial aging are lines and wrinkles that form in the forehead and between the eyebrows. As a reflection of the numerous muscles that make our facial expressions, wrinkles inevitably form in linear arrangements that are perpendicular to how the underlying muscles are oriented and move. This is ideally what Botox injections treat…dynamic forehead wrinkles.
One other important component of upper facial aging is the position of the eyebrows. With enough downward pull of the central forehead muscles over time, the eyebrows will eventually slide off to some degree from the brow bones. Know as brow ptosis, it makes one’s appearance older, tired or even angry. This is what browlift surgery treats…correction of non-dynamic or static brow sagging.
But browlift surgery understandably gives one pause as it is an invasive procedure that involves recovery and some risks. But the strategic placement of Botox injections can create a browlift-effect in some patients that may even rival that of some browlift surgery results. By chemically weakening or even paralyzingthe eyebrow depressor muscles, the eyebrows will raise with the unopposed action of the elevator muscles. This has led to the concept of a Botox Browlift.
The Botox Browlift is effective for either naturally or age-induced low hanging eyebrows. With good injection placements, the skin above and around the eyebrows is lifted so the eyebrow position is a few millimeters higher. Like all Botox injections, their effects will last around four months or a little longer in some patients. The downside, of course, is that its effect are not permanent or relatively short-lived. But that is the trade-off for a non-invasive procedure.
If you have low brows or brow sagging should you have Botox injections or browlift surgery? The answer depends on several factors including one’s age, amount of forehead wrinkles and brow sagging and what other treatments one’s face may need. The most important concept to understand is that a Botox Browlift produces a minor or a few millimeters of change at best. While it can never create an overcorrected or ‘deer in the headlights’ brow elevated result, its concern is whether it can make enough of a visible change. Conversely, browlift surgery depending on the technique used always creates a noticeable change and its concern is whether the effect may be too much or create an unnatural shape to the arch of the eyebrows.
The Botox Browlift technique is useful for many patients and should always be tried first when one has brow position concerns. Even in brows that are quite low it may be beneficial. But injection technique is important and it is just as easy to exacerbate brow sagging rather than create brow elevation if not done properly. If one is considering eyelid/blepharoplasty surgery for removal of skin and fat around the eyelids, this is the ideal time to determine if browlift surgery would be complementary.
The Botox Browlift should not be assumed to be comparable to browlift surgery. They sound similar but their indications and effects can be quite different.
Dr. Barry Eppley
Indianapolis, Indiana