Brow and Forehead

The Ideal Brow Position

The brows act to frame the eyes and are key to our many nuanced facial expressions. The ideal aesthetic position of the brow in a woman takes finds its course just above the bony orbital rim, or the firm ridge of bone above the eye; the male face features a relatively flat brow that rests at or slightly below the bony orbital rim. With aging and genetic factors, brow descend and bring heaviness to the eyes; this can make us look tired, sleepy, or sad.

The eyebrow and the upper eyelid are closely related. Sometimes, when eyebrows descend and make the eyelids look overly heavy, some people may believe they need eyelids treated. In reality, lots of individuals with heaviness in the upper face–a tired or a sad look–may need their foreheads and brows repositioned, often in combination with eyelid rejuvenation.

Treatment of the heavy brow can be performed via several approaches:

1. Botox and Dysport – In some patients, treatment of the forehead and smile lines around the eyes can allow for a slight lift of the brow’s tail. Subtle and natural, this “Botox brow lift” can do wonders for opening the eyes. Not appropriate for all patients, this treatment must be carefully tailored to each person’s individual anatomy. Those with particularly heavy brows may note worsening of brow descent with forehead treatment; experience with injections and a conservative treatment approach are key in having a good outcome with Botox and Dysport.

2. Injectable fillers – Some dermal fillers may be used to sculpt the upper eyelid and eyebrow ridge. While this does not actually elevate the brow, additional volume below the brow can result in less shadowing around the eye and an overall rejuvenated brow appearance. Most injectable fillers last 1-2 years in the area around the eye, and can at times prove a result that rivals surgical outcomes.

3. Endoscopic Brow Lift – A minimally invasive approach, endoscopic brow lifting employs 4 small incisions in the scalp and a camera to guide dissection under the skin. Accessed via small incisions, the brow is gently separated from the brow bone, and lifted to a higher position. tissues and elevated to a new position. The brow and forehead tissues are held in place with small absorbable implants (called Endotines) placed under the skin.

4. Temporal / Lateral Brow Lift – This treatment allows for lifting of the outer brow via an incision hidden in the scalp. Excess skin is removed, which allows for smoothing of the skin at the side of the brow.

5. Forehead Lift – A forehead lift addresses the entire brow and forehead; this treatment involves an incision placed at the hairline or behind it. This treatment is best for treating heaviness at the central brow and at the glabella (or frown complex). A forehead lift may also incorporate weakening of the frown muscles, and relax the “11s” or frown lines.