One of the most prominent facial area that changes as we age is that of the eyes. Known collectively as the periorbital region, it includes the eyelids, brows and all of the attached soft tissues. Periorbital age changes include brows that fall, eyelid skin that becomes excessive, and fat atrophy around the bone of the eye that can make it appear more prominent.
The role of injectable treatments for the aging periorbital region has largely been that of weakening the muscles to decrease frown lines and crow’s feet wrinkling. The use of the other form of injectable treatments, fillers, has heretofore been of minimal value for improving the appearance of aging eyes. It has traditionally been the role of surgery to provide real improvement in this facial area.
One new use of injectable fillers around the eye is to add volume to the sagging brow by injecting along the brow line. Filling in the brow helps lift it which can make the eye more open, longer and fuller, all characteristic features of a more youthful eye. The injections can be threaded into the brow, usually placing more to the outside of the brow. Injecting to the inside must be done with care as the feeling nerves to the forehead, with blood vessels, come out of the brow bone in this area.
While the standard method for adding volume to the brow has been with injectable fat, its retention is highly variable and does require a harvest site and a method of fat preparation. Off-the-shelf injectable fillers avoid these steps and provides an immediate effect that will last as long as the filler’s composition allows. Hyaluronic acid-based fillers, such as Juvaderm, provide an injectable gel that is soft, easy to inject, moldable, and has a numbing agent in it. While it is not permanent, it appears to last longer in the brow that other facial areas. It will usually last at least one year and often longer. That may be because it is not exposed to a lot of facial movement, unlike the lips or nasolabial folds.
Injection into the brow does not require a lot of volume, often as little as 0.2 to 0.4ccs is all that is needed per brow. It is best to begin with small volumes, more can always be added later. Combining brow volume enhancement with Botox or Dysport in the glabellar and lateral canthal areas can provide a nice rejuvenative effect that looks natural and non-surgical.
Dr. Barry Eppley
Indianapolis Indiana