Fixing common problems of the face

Eyebrow Drooping and Elevation

Perhaps you are one of those people who has discovered more skin hanging on your eyelid than you had in the past. Or maybe you’re someone who, like me, prefers a flat eyelid and more arch or lift to your eyebrows. Models in fashion magazines seem to all have beautiful, arched eyebrows, but for many of us, that is not how we were born.

We look for a solution to give us a more awake appearance and a more arched look to our brow, without that awful surprised look we see in Hollywood or on those “Housewives” reality shows. If you’re like me, you’ve tried to tweak your brows to give them an arch shape, but unfortunately it often fails. Here’s your solution.

They say the eyes are the entry to your soul, so what should you do when the skin above your eyelid has drooped so much that you always look tired? One of the most common complaints among my clients is the increasing amount of skin of their eyelids. Many women – and men – in my office complain that they want their eyebrows raised to decrease the amount of skin of their eyelids. I find clients as young as their mid-20s suffering from eyelid drooping. Since it gives a constant fatigued look, it is an undesirable problem that most people want fixed.

For some people, this is a genetic problem. Eyelid hooding, or ptosis, is a genetic trait, and if your mother or father has it, I’m sorry to say that chances are high you will have it. Unfortunately, it can also just be a symptom of aging, as the muscle that lifts the eyelid begins to thin. Eyelid drooping occurs when the muscles that raise the eyelid are not strong enough to do so properly. Sometimes it affects both eyes, but it can also affect one eye, or the problem can be asymmetric, meaning one eyelid is worse than the other. We’re constantly taking patients who looked tired because of drooping eyebrows and transforming that look into a more welcoming and enthusiastic appearance.

So, how do we do it? Blepharoplasty is a common surgical procedure for eyelid ptosis that is performed as an outpatient procedure, with little downtime and discomfort. I consider it to be one of the easiest in the vast range of surgical procedures, and I often urge my clients who have eyelid ptosis to opt for this procedure. It is performed using a local anesthetic and simple IV sedation. Your surgeon will simply excise the excess skin that is hanging over the eye.

For many reasons, surgery is sometimes not a viable option. Or, perhaps you just don’t want to have surgery. That’s fine, because surgery is no longer the only option for eyebrow elevation. Modern techniques, including Botox and lasers, can help elevate the eyebrow, opening up the eye and giving a more awake and alert look. Here’s what you can do.

Botox for Brow Lift

I estimate that nine out of ten women who sit in my chair ask me to elevate their eyebrow or eyelid. It is now possible to get this brow lift or shaping with Botox, Dysport or Xeomin. The technique is a wonderful way to raise the outer part of the eyebrow or lift the medial border of the brow, creating not only a more desirable shape to the eyebrows, but also opening up the eyes. However, this is a technique that takes an experienced, skilled injector, not a novice. Only a skilled and experienced injector understands not only how the muscles of the face work but can also look at your unique face to assess what type of elevation would be best to alleviate your symptoms.

You can get a brow lift depending on where Botox is injected. To get a lateral brow lift, your injector will treat the crows feet area, as well as a little under the lateral or outside aspect of the eyebrow. To get a medial lift, your injector will treat your frown lines, in what we call the glabella region. As we know, the forehead is the elevator muscle of the face, and the frown is the depressor muscle in the face. If we knock out the depressor muscle, the brow will lift naturally. This allows the medial or middle aspect of your brow to be elevated, thereby raising the eyebrow. Essentially, Botox works to weaken the muscles that pull the brows down. We also like to treat the crows feet, on either side of the eyebrows. When these muscles stop contracting, it allows the brows to rise naturally.

It is important, when choosing an injector, that you seek out a medical professional who understands what you are trying to achieve. He or she should have a discussion with you as to how it will be done, and don’t be shy during that discussion. The only way to truly get exactly what you want is to let your injector know exactly what you want. So speak up and let me know exactly what you’re hoping to achieve. I can’t tell you how many times my patients come in for follow-up treatments, and they tell me the injection didn’t achieve what they had hoped for. More often than not, this happens because I’m left in the dark during initial treatment.

On the whole, this is fairly rare, however. My clients are usually pretty pleased with the results, and the only downside is that the results only last between three and four months before a repeat treatment is needed. Unlike surgery, which will essentially permanently fix the problem, this is a treatment that will need to be repeated several times a year to maintain the arch or lift you desire. As with any injection, there is relatively no downtime, and the effects will become apparent in approximately one week.

Ultherapy for Brow Lift

For whatever reason, some people don’t want Botox, but they are still seeking a solution to lift their eyebrows. Or, some want Botox and then want to take their eyebrow elevation one step further. Ultherapy can do just that.  

As we discussed previously, Ultherapy is a wonderful new nonsurgical facial rejuvenation treatment that offers a noninvasive tissue lift, using medical ultrasound. In a clinical study at Northwestern University, physician evaluators noted a significant lifting of the brow line from Ultherapy. The excess skin on the upper eyelids, caused by the drooping brow, can simply be raised, giving a more open eye and more rested and refreshed look.

Ultherapy triggers the body’s own regenerative process, which is to rebuild the supportive collagen fibers within the skin. Over time this results in a firming, tightening and lifting of the skin tissue. The effects are wonderful and take place naturally and gradually. Treating above the eyebrow, Ultherapy offers approximately a two millimeter lift, which may not seem significant, but in an eyebrow it makes a world of difference.

My clients seem satisfied with the amount of lift achieved from the procedure. Sometimes I do have to repeat it, but it’s a small price to pay for nonsurgical procedure that will open up the eyes and alleviate some of that heavy drooping skin of the eyelid. There is no downtime with this procedure, other than possibly feeling a bit sore to the touch for a few days. You can go back to work immediately and get on with your life, while the eyebrow gradually raises over the course of one to three months, with maximum results at the six month point.

Liquid Brow Lift

Yet another treatment can elevate the eyebrows and relieve drooping eyelids: a liquid brow lift. Those of us who are experienced in advanced liquid facelift techniques can help lift a drooping or hooded eyelid, using dermal fillers. As I described in detail in an earlier section, Restylane or Juvederm are effective treatments to lift the upper eyelids when they are placed immediately behind the eyebrow. This technique provides a gentle lift to a sagging eyelid. It can also help accent the brow line, as we unfortunately find that, as we age, the brows tend to sit more flat against our face. Dermal fillers can help rejuvenate this area by providing a bit of extra volume behind the eyebrow.

Another region that can be treated with one of these products to subtly lift the brows and eyes, as well as other parts of the face, is the temple area. I love using dermal fillers to lift the eyebrow, and I often recommended, as an adjunct treatment, Botox, Dysport or Xeomin to provide the maximum lift to relieve eyebrow drooping and excess skin.

Radiofrequency for Brow Lift

Radiofrequency is another wonderful modality that can be used to achieve facial lifting. As you’ll recall, these treatments use a high-frequency electromagnetic wave, transmitted into subcutaneous dermal tissue, to stimulate contracting of existing collagen fibers, also encouraging fibroblast migration and promoting new collagen growth. All of this eventually leads to improved skin elasticity and texture.  

Treatments such as Thermage, Refirme, Accent and Viora, to name a few, offer another solution to eyebrow elevation. They are other no-downtime approaches, and they are a pain-free procedure that uses radiofrequency heat to shrink tissue and rejuvenate collagen to the area being treated. However, anywhere from two to eight treatment sessions will be required in order to achieve the maximum result, and of course, with all radiofrequency treatments, some maintenance will be required to maintain the result. I often suggest this to my clients as an adjunct treatment to Botox or other dermal filler to elevate the eyebrow. This treatment, along with all the other treatments that have just been discussed, allow you to go right back to work or resume normal daily activities immediately following treatment.

Choosing what technique is best for you will be something that you and your medical provider discuss. The beauty of my practice is that we not only offer Botox and dermal fillers, we also have more than ten different lasers to help to elevate and lift the eyebrows. My suggestion is to seek out a practice that offers many solutions in the form of both injectables and lasers.

Sometimes it’s best for people to start with one procedure, such as Botox or a dermal filler, and then take the next step, if necessary. Or, perhaps you would like to begin with a laser and then move on to Botox or dermal fillers. Whatever the case, it is important that you find a clinic that offers several different technologies, as there is no one treatment that is right for everyone, and varying results will come with the intensities of the treatments. But first and foremost, I urge you to have a conversation with your medical provider and discuss openly your needs and desires so that you can determine what type of solutions they can offer and whether that fits within your budget and lifestyle.

By | 2017-03-21T16:00:42+00:00 March 21st, 2017|The Face|0 Comments

About the Author:

I come from a long line of doctors and scientists, famous musicians, composers, artists and opera singers. I am tone deaf, cannot read music and cannot draw a stick figure to save my life, but all of these artists, doctors and scientists left a legacy that has guided me throughout my professional life. I have never been able to shake a love and admiration for the art and science of medicine that they all inspired in me. As the daughter of a prominent Chicago cosmetic surgeon, I grew up with a passion for cosmetic medicine. Dinner table conversations were peppered with words like ‘liposuction’ and ‘vein removal.’ While most of my school friends took family trips to Florida for spring break, my family traveled to Paris so my father could learn about advancements in cosmetic medicine. In fact, in grade school, I was teased relentlessly about the fact that my dad sucked the fat out of people. Little did they know that many of them would become his patients later in life and would ask for the very procedure they used to tease me about. After more than twenty years in the business myself, it's safe to say that I have a passion for medicine, specifically, for the art of cosmetic medicine. Perhaps I inherited it. I like to think I did. And to my surprise, I find that I am an artist after all. Who cares that I can’t draw a stick figure? I can create exquisite lips, erase years of wrinkles, and restore youthfulness to skin without breaking a sweat. The beauty of cosmetic medicine is more than skin deep. The beauty of the craft lies in the fact that it is both a science and an art, and a skilled practitioner can use its potential to create a masterpiece. So, take that, Michelangelo.

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