Though drooping brows are not a gender-specific problem, few facial changes evoke the image of a crotchety old man more than a saggy periorbital region. Due to the framing features of the brow, they can either project a bright, fresh appearance when lifted, or an old, tired one when aging takes its toll. Fortunately, through both surgical and nonsurgical methods, brows can be restored to their youthful position, causing the whole face to open up and lift off the effects of time, not to mention that old man in the mirror.
Botox and fillers
If you're looking for a quick fix that requires little pain and no downtime, you might want to consider a nonsurgical method, such as Botox or fillers. However, the change will not be as dramatic as a surgical option, says Joseph Niamtu III, D.M.D., a board-certified cosmetic facial surgeon in Midlothian, Va. "In terms of approaches to the brow, you can effect minimal to moderate — and that's pushing it — changes by using Botox and/or fillers," he says.
When talking about Botox, Dr. Niamtu thinks lateral elevation of the brow is incidental, and therefore unpredictable.
"The mechanism for Botox is selective paralysis of the depressors, which encourages the brow elevator (frontalis muscle) to actually lift the brow, and by precise control of what you treat and what you don't treat, sometimes you can get some lateral elevation of the brow. In my opinion," Dr. Niamtu says. However, he adds that he doesn't think the effect is as predictable as the result of other procedures.
Fillers are a more predictable, way to noninvasively correct the brow area by plumping areas with tissue loss.
"As we age, we have lots of changes in the upper face, including some shrinkage of the skull, loss of fatty tissues around the (eyes) and skin changes from sun damage and gravity," he says. He adds, the upper brow might sag, and replacing some of that volume around the eyebrow can improve those areas.
Fillers are lunchtime procedures that provide instant gratification, last eight months to a year, and not much filler is needed for the correction, Dr. Niamtu says.
According to Dr. Niamtu, 12 years ago the endoscopic brow lift changed the paradigm for the management of brow. As a less invasive method for addressing the brow and forehead, it became a popular technique.
However, becaues it is less invasive, a large number of surgeons argue the effects don't last as long as other techniques, Dr. Niamtu says. An alternate surgery is trichophytic technique, in which "an extreme beveled incision is made approximately 5 mm behind the hairline," Dr. Niamtu explains. When the skin is sewn back, the hair will actually regrow through the scar and camouflage it, he adds. In this case the hairline can sometimes be lowered, as opposed to other techniques where the hairline is raised. Results of both techniques can last a decade or more, he says, though no procedure can completely stop the aging process.
Is a browlift the right procedure?
"Not every patient looks better with a browlift," Dr. Niamtu cautions. He suggests showing your doctor a younger photo of yourself, warning that some people actually would look abnormal with elevated brows.
Bottom line: it's important to discuss and plan with your doctor, because nothing "stands out more hideously than an overcorrected brow, hence everybody asking about Kenny Rogers."