What works and what doesn’t – and how the results differ from brow lift surgery.
If you have recently noticed your brows drooping, you’re probably searching for ways to address it. Maybe you’ve considered having a brow lift, or maybe you’d prefer something less invasive.
Over the years, many “alternatives” to brow lift surgery have been touted. But do any of them work? To find out, Zwivel decided to go straight to the source. We asked both the current President and President Elect of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) to weigh in on a number of these so-called alternatives and clear up the confusion. Here is what they had to say.
The Claims: Botox is most often used to treat crow’s feet, wrinkles, and deep creases on the forehead. But Botox and other neuromodulators have also been touted as a way to lift drooping eyebrows.
Botox works by relaxing underlying muscles. The position of the eyebrows is largely determined by two such muscles, one of which pulls the brows downward and the other which pulls them upward.
Proponents of Botox to lift the brows say that a few carefully placed injections of Botox along the brows can weaken the muscle that pulls the brows downward, in turn lifting the brows slightly. They also point out that, unlike surgical brow lift, Botox injections only take a few minutes and are nearly pain-free. And, in most cases, it’s possible to return to work and everyday activities immediately after Botox injections.
What the Experts Say: It works.
“This is highly effective,” says Fred G. Fedok, MD, FACS, President of the AAFPRS. According to Fedok, Botox can be a good treatment option for patients who are concerned about lateral brow droopiness. He says that a large percentage of these patients can achieve several millimeters of lateral brow elevation by having Botox injected into the vertical portion of the orbicularis (a facial muscle that closes the eyelids).
This sentiment is echoed by William H. Truswell, MD, President elect for AAFPRS. “A small amount of Botox will lift the lateral brow 2-3 mm in most patients,” says Truswell. “The effect will last 3-4 months on average. It prevents the brow depressor muscle from working and the natural tone of the frontal muscle which lifts the eyebrows will draw them upwards.”
Fedok notes that in some patients Botox can have a similar elevating effect in the medial brow.
Truswell cautions that if misplaced, Botox can actually make the eyelid drop. He also notes that injections of any type can result in bruising.
Brow Lift Tape
The Claims: There are several tape products on the market that purportedly reshape the eyelids by lifting the extra skin over the natural lid crease.
These products are advertised as a discrete, low-cost alternative to plastic surgery. Users can even apply makeup over the adhesive strips. Tape products are also said to produce a more natural, “less surprised” look than surgery, taking years off of the user’s appearance.
Verdict: Not a serious solution.
Our experts do not consider tape a real solution to droopy eyebrows, but they note that some plastic surgeons do use tape as part of the eyebrow lift procedure. “Some surgeons recommend taping of the brow as an adjunct after surgical brow lifting to aid in optimal healing,” says Fedok.
Truswell concurs, saying the eyebrows can be taped up for a few hours. “The tape will be visible unless bangs or cosmetics are used for camouflage,” he adds. Truswell also notes that the adhesive strips can irritate the skin in some cases.
The Claims: Proponents of facial filler injections in lieu of surgical brow lift claim that a few carefully placed injections of facial fillers like Juvederm, Restylane or Radiesse can instantly lift saggy skin and restore the natural position of the brow.
When we are young our brows have a “full” appearance, but as we get older, our skin becomes lax and begins to sag, and this makes the brows move downwards. As with Botox, filler injections are minimally invasive, nearly pain-free, and take just minutes to perform, so you can return to work and daily activities shortly after the treatment.
Verdict: Sometimes effective.
According to Fedok, eyebrow droopiness is the result of many processes, including deflation of soft tissue fullness under the lateral brow as well as laxity of the skin itself. The injection of fillers or fat below the eyebrow restores fullness and thus causes a noticeable elevation of the brow. “I find this to be most effective in the lateral half of the brow,” he says.
Truswell says that injection of a small amount of facial filler beneath the brows can push the brow out and up a bit. He adds that filler injections above the brow – towards the temple – can elevate the brow by pulling upward. As with Botox, Truswell cautions that filler injections can cause some bruising, and he points out that injections can lead to asymmetry if poorly done.
Eyebrow Lift Cream
The Claims: Applying anti-aging creams to the eye area and above the eyebrow can lift, tighten and firm the skin.
Proponents of this method tout it as a quick, painless, inexpensive way to achieve a brow lift. They also claim that this inhibits the contraction of muscle cells, lifting the eyebrow.
Verdict: Minimally effective.
Truswell says that there is no supportive evidence to show that application of eye creams will lift the brow. Moreover, he says, doing so can irritate the skin of some patients and cause an allergic reaction.
Fedok is somewhat less skeptical. “I am a big fan of cosmeceuticals,” he says. “At times, depending on the active ingredients, there can be improvement in skin tone and texture which produces some minimal tightening. The creams have to be used continuously to maintain any of the beneficial effect.” But he also emphasizes that cosmeceutical eye creams do not, in his experience, work to the extent of the neuromodulators (Botox), fillers, or surgery.
Eyebrow Lift Exercises
The Claims: Why put yourself through the time and expense of surgery when you can simply do some eyebrow exercises?
Proponents of this supposed eyebrow lift alternative say that a few minutes of massage and eyebrow lifting can strengthen the entire eye area, tone the face and even make the whites of your eyes whiter.
Verdict: Ineffective, possibly counterproductive.
Truswell puts it bluntly. “This will have no effect,” he says.
Fedok agrees. “Considering any and all exercise would be temporary and short lived compared to the rest of the day we are existing under the influence of gravity, I do not believe these will have a long-term positive effect on brow position,” he says. “I believe it is equally likely that [these exercises] would contribute to other muscle related aesthetic issues such as glabellar furrows, forehead wrinkles, or crow’s feet.”
The Claims: Moderate skin tightening.
While skin resurfacing treatments may help tighten loose skin around the eyes, these procedures fail to significantly lift the brow area. According to recent studies, “Periorbital rejuvenation using lasers is largely one of tightening the periorbital skin to some degree; it has little effect on subcutaneous fat or any long-term effect on brow posture.”
Verdict: Somewhat effective.
“In some patients, moderate and deep resurfacing, whether chemical or light based, can produce skin tightening and brow elevation,” says Fedok.
How Do Non-surgical Treatments Compare to Surgery?
As we have learned, some non-surgical treatments can be somewhat effective. For certain people, these treatments might be the best solution to droopy brows. “Neuromodulators, fillers, and fat transfer have the ability to produce significant results, albeit not as effective as surgery,” says Fedok. “In some patients, depending on age and goals, these nonsurgical interventions may provide the look and lift that they are seeking.”
But, ultimately, we probably shouldn’t kid ourselves. Surgical brow lift is by far the most effective treatment to address drooping brows. “Surgery is by far the best and more natural method and it lasts for many years,” says Truswell. “There is really no replacement for surgery in providing natural and long lasting results to rejuvenate, refresh and feminize the aging female face… In over 40 years of doing this surgery I never encountered a problem.”
Fedok agrees. “It is the surgical brow lifts, of several varieties, that provide the time proven results that people seek,” he says.
And Truswell points out that while many non-surgical treatments do provide good results, it’s a buyer-beware market. “The beauty industry is more than a billion dollar per year industry,” he says. “There is a lot of smoke and mirrors out there and the public must do due diligence in investigating and researching products, treatments, procedures and even surgeons.”