Droopy eyebrows

The face is the most visible determinant of an individual’s perceived age. A youthful forehead is characterized by smooth skin without wrinkles or pigmentary changes, a short hairline-to-eyebrow distance, well-positioned eyebrows, and well-contoured temples.

In women, eyebrows lie just above the upper margin bony eye socket, and forms a gentle arch toward the lateral (outer) side. In men, the eyebrows lie at the upper margin of the eye socket and are normally flat.

How Does It Manifest?

Aging changes in the forehead start to manifest in the third decade of life. Individuals with droopy eyebrows present with elongated hairline-to-eyebrow distance, which may be further contributed by a receding hairline in some males. The eyebrow descends below the bony eye socket, causing drooping of the upper eyelid skin and visual obstruction.

Individuals often subconsciously strain their forehead (frontalis) muscles to lift their eyebrows to relieve this visual obstruction, causing formation of deep horizontal forehead wrinkles with time. The eyebrow drooping and visual obstruction is normally worse at the end of the day, due to fatigue of the frontalis muscles. 

Other changes visible in an aging forehead include irregular forehead contour and sunken temples due to loss of subcutaneous fat. Individuals with an aged upper face are often described as angry or frowning, or appear tired.

How does it arise?

Facial aging is a complex process and is multifactorial. The forehead is a good example of this. Droopy eyebrows are the result of progressive age-related skin laxity and lengthening of forehead (frontalis) muscles and ligaments that anchor the eyebrows to the underlying skull.

After the third decade of life, the skin becomes thinner and loses elastic recoil due to reduced production of elastin and collagen fibers. There is reduction of the subcutaneous fat volume that contributes to skin excess. The muscles and ligaments are chronically stretched and become elongated. There is gradual descent of the eyebrows below the upper margins of the eye sockets; this causes upper eyelid skin descent and visual obstruction.

 

Will I look unnatural?

It is critical to differentiate between droopy eyebrows and droopy upper eyelids and individuals often have varying degrees of both. It is essential to treat the eyebrow before elevating the upper eyelid skin to avoid unnatural and suboptimal results. Attaining attractive and elegant results is frequently possible and requires a combination of accurate assessment, precise technical execution and an experienced practitioner.

treatment

The optimal treatment for droopy eyebrows depends on their severity and the individual’s treatment goals. The common treatment methods include: botulinum toxin injection, microfocused ultrasound ultrasound brow lift, minimal-incision brow lift, and brow lift.

All options are effective and safe treatments in experienced hands. Successful eyebrow rejuvenation relieves upper eyelid obstruction and improves the overall aesthetic. It improves self-confidence and social functioning.

Botulinum Toxin Brow Lift

Brow lift may be achieved by partial weakening of the brow depressor muscles and attains a high degree of satisfaction in most cases. The popularity of botulinum toxin injection has grown rapidly since the 1990s, and it is now one of the most commonly administered procedures in the world. A detailed explanation of botulinum toxin (Botox) treatments may be found. 

Individuals with early eyebrow descent, have good skin quality and minimal laxity are ideal candidates for botulinum toxin injection. These are usually individuals in their thirties or early forties.

We frequently see or hear of people who look unnatural following aesthetic treatments. This is often due to practitioners who attempt to reverse all the signs of aging by using botulinum toxin alone, resulting in stiff and unnatural results. Botulinum toxin does not reverse skin and muscle laxity or fat atrophy. Attaining bespoke and natural-looking results that retain an individual’s expressivity is frequently possible and requires accurate assessment, appropriate product choice, precise administration by an experienced practitioner.

Botulinum toxin causes partial weakening of the orbicularis oculi muscle at the tail of the eyebrow. This muscle normally exerts a depressive force on the eyebrow, and its weakening allows gentle brow elevation. A single injection to this area achieves a simple and effective lift in appropriate individuals.

The effects of botulinum toxin take 1 to 3 days to be observed, and will last for 4 to 6 months. Repeat treatments are necessary for maintenance of the result.

Individuals are advised to avoid vigorous massage to the treatment area for 2 hours following the injection. This is to prevent spread of the botulinum toxin, which may result in potential unintended adjacent muscle paralysis. Individuals may resume their usual activities immediately following the procedure.

Droopy Eyebrows: Botox, Microfocused Ultrasound, Minimal-Incision Brow Lift & Surgery

Microfocused Ultrasound Brow Lift

There is an increasing demand for non-surgical facial rejuvenation and microfocused ultrasound (MFU) has emerged as one of the effective and safe technologies for tightening the skin and subcutaneous tissues. This is a popularly requested procedure for rejuvenation. The MFU brow lift is an ambulatory procedure performed under a local anaesthesia nerve block with intravenous sedation for optimal effect.

Individuals with early eyebrow descent, good skin quality and minimal laxity are ideal candidates for MFU brow lift. These are usually individuals in their thirties or early forties.

MFU uses microfocused sound waves that generate vibration and heat at specific points in tissue. This creates discrete areas of controlled thermal injury zones at predetermined depths, leaving the surrounding tissue undamaged. At these areas of thermal injury, the collagen contracts and is eventually absorbed by the body, and new collagen production stimulated, resulting in skin renewal. Here is a detailed explanation of MFU treatment

Administering effective and safe treatments are the cornerstones of our care delivery philosophy at Picasso Plastic Surgery. Effective MFU treatment requires repeated delivery of high doses of energy, which may sometimes render the treatment slightly painful. Utilizing our detailed knowledge of anatomy, MFU treatments are performed under regional nerve blocks with local anesthesia for maximal comfort, with optional intravenous sedation if individuals request for it. This allows individuals to tolerate higher doses of treatment to obtain a visible clinical effect in a safe and comfortable manner. Individuals who do not receive optimal analgesia often receive suboptimal treatment doses and may attain less satisfactory results. Our clinic uses the Ulthera (Ultherapy) system, which is the most extensively studied MFU device and was approved by the United States Food and Drug Administration in 2009 for non-surgical skin tightening.

The effects of MFU may be observed almost immediately following the procedure. The treated areas continue to undergo collagen production, subcutaneous remodelling and tightening up to 3 months post-procedure. In most cases, the effects are sustained for 6 to 9 months, and repeat treatment is required to maintain the result.

There are no wounds and no special post-procedural care is required. Individuals may resume their usual activities following the procedure.

Minimal-Incision Brow Lift | Temporal Brow Pexy

The minimal-incision brow lift delivers effective and sustained moderate brow elevation through incisions hidden within the temple hairline. The minimal-incision brow lift is an ambulatory procedure that is performed under local anaesthesia, with optional intravenous sedation if requested.

Individuals with mild-to-moderate brow drooping and seeking long-term eyebrow elevation are ideal candidates for the minimal-incision brow lift. Individuals who have had suboptimal result with non-surgical methods may also consider this procedure as a good alternative.

Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.

An incision is made within the hair-bearing portion of the temple; this results in a well-hidden scar when healed. The skin and muscle are elevated downwards and inwards towards the tail of the eyebrow. In order to attain a natural postoperative result that retains eyebrow movement, meticulous surgical technique is required here to preserve the relevant nerves.

The eyebrow is then released, elevated upwards and outwards and anchored to deep tissue in the scalp. The excess skin is removed and the incision closed carefully for an optimal postoperative results.

Mild bruising and swelling is expected, which will mostly resolve by the 7th postoperative day. The swelling is often more visible in the upper eyelid region than in the forehead because the eyelid skin is thinner. Stitches are removed on the 10th postoperative day and most individuals are able to return to work by then.

Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Gentle hair washing is possible from the second postoperative day onwards. Strenuous activity should be avoided for the first two weeks to minimize bruising.

Brow Lift

Brow lifts are the most comprehensive method of addressing the components of forehead aging and produces exquisite, bespoke and sustained forehead rejuvenation. Brow lifts are ambulatory procedures performed under intravenous sedation or a short general anesthesia.

Successful brow lift surgery improves the overall forehead aesthetic in a harmonious manner. It improves self-confidence and social functioning.

The following are good candidates for surgical brow lifts:

  • Individuals with significant forehead skin laxity and forehead lengthening
  • Individuals with visual obstruction from droopy eyebrows
  • Individuals with deep horizontal forehead wrinkles
  • Individuals with forehead contour irregularity due to age-related fat loss
  • Individuals who have had suboptimal result with non-surgical treatments

Brow lift surgery will deliver sustained reduction of horizontal forehead wrinkles and forehead height, elevate eyebrows to their natural position, restore an aesthetic brow shape and relieve visual obstruction. The scars are well concealed within the hairline.

Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.

An incision is usually made behind the hairline, and the forehead skin and muscle is lifted off from the underlying forehead bone. The eyebrows are fixed in the correct position, and the excess skin and muscle removed. Skin closure is also performed in a meticulous manner to optimize wound healing and camouflage its final appearance. Brow lift surgery restores the brow to the appropriate position and recreates an aesthetically appropriate shape. It is a fine art and requires appropriate technique selection, precise execution and an experienced practitioner.

Dr Yeo is experienced with surgical brow lifts and incorporates proprietary techniques to deliver exquisite and sustained results while minimizing the postoperative recovery time. The initial skin incision is performed using a special angled technique for preservation of the hair follicles, so that hair will eventually grow through and camouflage the scar.

A special wound closure technique is used to optimize the final postoperative scar appearance. Our clinic has an en suite operating facility, which assures your maximal privacy and convenience and keeps facility and equipment costs contained. Our operating room carries a full range of equipment tailored for brow lifts.

Mild bruising and swelling is expected, which will mostly resolve by the 10th postoperative day. The swelling is often more visible in the upper eyelid region than in the forehead because the eyelid skin is thinner. Stitches are removed on the 10th postoperative day and most individuals are able to return to work by then.

Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Gentle hair washing is possible from the second postoperative day onwards. Strenuous activity should be avoided for the first two weeks to minimize bruising.