PROBLEM

The level of the eyebrow has both functional and cosmetic importance. It is necessary to have the brow at or above the orbital rim in order for the upper eyelid to function properly in upward field of vision.   Also, the eyebrow level indicates ageing with the brow descending over time, especially medially towards the nose and laterally.  The brow also loses it's arch and becomes flat with time.  The forces on the eyebrow include genetics, amount of squinting, contraction of the orbicularis laterally and the procereus and corregator muscles medially.

PROCEDURES  

Botox, Mini browlifts, Complete browlifts

PRE-OPERATIVE EVALUATION

The optimal brow location is right at the orbital rim, with a gentle arch. Eyebrow levels above the rim may be natural but if surgically done can make you look surprised. Most women want a smooth arching eyebrow. Most men accept a slightly lower level.
It is important to evaluate current hair position, estimated hair position and scarring potential.  Eyebrow ptosis or droop can be corrected depending upon the extent - mild, moderate, or severe.

Mild - if the eyebrow is down minimally at the rim.
Moderate - the eyebrow is at the lower aspect of the rim or down laterally.
Severe - the eyebrow is below the level of the rim.

TREATMENT

Mild - Botox.

If the eyebrow is down minimally at the rim, then Botox may be the answer. Injections of Botox on a regular basis causes the depressors laterally and medially to become weak. This will elevate the eyebrow, especially if the frontalis muscle is not injected.

Moderate and Severe
If you have congenitally low eyebrows, are over 40 years and have low eyebrows, the best is to do an eyebrow lift. My experience has been that Botox will not improve this situation.

The type of correction depends upon the extent of ptosis. The traditional coronal, over the top, incision is rarely done - only for extensive excess skin. Mini browlifts involving fiberoptic instruments or shorter modified incisions with small instruments work well. Only very rarely is hair bearing skin removed. All of the tension is placed deep, on the fascia or fibrous tissue. Indeed, I have performed brow elevations on bald men with incisions being barely visible.

ANESTHESIA TYPE

IV sedation or topical for Botox

RECOVERY

Botox - None.
Mini Browlifts - 2-4 days.
Complete Browlifts - 3-5 days.