Posted: 12:01 AM Aug. 18, 2019
By Anita Mandal, M.D.
Question: I am going to have my 70th birthday later this year. I decided to have some facial rejuvenation treatments but prefer not to have surgery due to the risks and need for anesthesia. I’m a happy person but people often say I look angry or upset. My sagging eyebrows make me look that way. What are the treatment options without surgery?
Answer: Sagging brows can have multiple causes. The correct treatment depends on the cause and location of sagging. One must also differentiate between heavy brows and heavy upper eyelids since, again, the choice of treatment varies. Additionally, men and women have differing anatomies with different requirements.
The eyebrow can be divided into three parts. The inner brow is often where one develops frown lines that deepen with age. Effective non-surgical treatment of this area can be achieved with Botox which relaxes the muscles that cause frowning. Currently there are four FDA-approved neuromodulators on the market. These include Botox cosmetic, Dysport, Xeomin and Jeuveau.
In some cases, these frown lines become so deep that grooves form between the eyebrows and require injectable filler for correction. However, it’s important to note that if Botox is not done in combination with injectable filler for grooves between the brows, filler may not last as long as expected. Filler options include Restylane, Juvederm, Radiesse and Bellafill, the 5-year filler.
The middle third of the brow can also sag with age. While treatment to elevate this aspect of the brow is with Botox and not fillers, Botox is typically placed in the forehead to raise the central brow.
A sagging outer brow can have several different causes. In some patients, simply treating the forehead with Botox can help. Others may need a combination of Botox in the forehead with crows feet (laugh lines around the eyes) to give an outer brow lift.
Equally important, the temple undergoes volume loss with age. As this occurs, the outer third of the brow can become ptotic or droopy and botox won’t necessarily help. Volumization of the temples with injectable filler, sometimes with extension to and just under the outer brow, can effectively raise the brow.
Additionally, your surgeon must appreciate the key anatomic and aesthetic differences between the male and female brow. The male brow tends to sit in a lower position and have a straighter, less arched shape. Female brows are typically more elevated with an arch shape, especially in the middle third. Any type of brow rejuvenation should focus on restoring a natural looking brow and take gender differences into consideration.
Finally, a sagging upper eyelid must not be confused with a heavy brow to avoid a poor result and potential complications.
Correct diagnosis and treatment can be made by a Board Certified Facial Plastic Surgeon who thoroughly understands the complex anatomy of the upper face and is experienced in the various treatment modalities, surgical as well as non-surgical, in order to make qualified recommendations for the most optimal, natural results.
Dr. Anita Mandal is a double Board Certified Facial Plastic Surgeon practicing since 1998. She exclusively specializes in facial rejuvenation and non-invasive body contouring. In addition to being on the medical staff at Jupiter Medical Center, her offices house both surgical and laser suites. Dr. Mandal is committed to giving her patients the most natural looking results.