Award winning reconstructive surgeon Dr Sabrina Shah Desai explains the range of treatments available to treat an aging brow.
When it comes to facial tweakments, the brow and forehead are perhaps the most commonly treated areas. Botulinum toxin treatment, to reduce lines and wrinkles, is perhaps one of the most commonly known and administered options available. But why does our brow change as we age, and are there any other options other than wrinkle freezing to counter the effects of gravity?
First let’s take a look at what happens to an aging brow.
• Forehead and frown lines
Forehead lines - the horizontal lines that appear across your forehead tend to appear when we express emotion such as surprise, scepticism or when we look worried, to name only a few. Frown lines are those vertical creases that appear above and between your eyebrows. They are caused when we push our eyebrows together.
As we age, our skin loses collagen so its doesn’t spring back into shape so readily. As a result, lines in the brow can set in. For those of us who have a particularly animated face, or who habitually frown, the lines are likely to be a little more apparent and stubborn to treat.
• Drooping or sagging
The forehead can begin to sag as muscle tissues weaken with age, sun exposure or hereditary thinning of the skin. The technical term for this is brow ptosis. This is most noticeable near the tail of the brow (where the brow tapers to the temple) - an area where the forehead muscle that lifts the brow is weakest.
• Changes in symmetry
As we age, the symmetry of the brow can begin to alter, as the soft tissues around the brow and eyes diminishes at differing rates, leaving an asymmetrical look.
What options are available to treat the brow?
The great news there are a number of non-surgical and some surgical options available.
Relaxing the brow
To treat frown lines between your brows and elevate the height of your eyebrows botulinum toxin injections can be administered. The toxin relaxes underlying muscles to smooth the skin on the outside and relax the muscles between the brows. The treatment allows the forehead muscles to pull up the now-relaxed depressor muscles between the brows, thereby elevating the brows and opening up the eyes. Treatment can be administered from the aged 21 upwards with results visible from around a week. In order to maintain results, injections will need to be repeated every few months.
Treatment with toxins is extremely popular for the brow as it is relatively inexpensive (compared with a surgical face-lift, for example) and delivers reliable results in a short time frame. Be mindful that your range of expression may be limited following treatment due muscles being in a relaxed state.
Injectable dermal fillers are a very effective non-surgical means of rejuvenating the brow. Both HA and collagen stimulating fillers can be used to elevate the tail of the brow, and to add volume to hollowed temples. Small amounts of product are injected at targeted points, refilling areas which have lost volume and adding supporting structure to drooping areas of skin.
I often recommend long lasting collagen stimulating filler Ellansé, particularly to patients who require support for the tail of the eyebrow. Not only does the product re-volumise, it stimulates the body to create its own collagen, creating additional support and improving the skin quality. Unlike toxin treatments, dermal fillers do not freeze expression of the face.
Treatment with dermal fillers will produce and instant re-volumisng result. Collagen stimulation and skin quality improvements with Ellansé will have taken full effect within three months. Treatment last from 6 months- 2 years depending on the product used.
Fat transfer, also known as 'liposculpture' or, 'stem cell transfer' has become very popular in recent years. The advanced, improved techniques now allow for a much greater survival of fat tissue. The principle of the procedure involves the harvesting of fat from another area of the body, often the inner thighs or knees followed by fat purification and then finally re-injection into the brow and forehead. The procedure adds facial volume by acting as a scaffold for the skin, recreating a vibrant and youthful appearance.
It can take up to 6 months for a fat transfer to fully take effect, as some of the injected fat may be reabsorbed by your body during the first few months after the procedure, but the fat that survives generally continues to exist just like other living tissue in the body. A small amount of fat may continue to resorb over the next six months, but this is not generally noticeable.
High intensity focused ultrasound
High intensity focused ultrasound treatments are non-invasive and non-surgical - so a good option for anyone looking to lift the eyebrows and smooth their brow without needles. Treatment targets deep down in the dermis layer of the skin and delivers targeted energy specifically into the deep, structural tissues where the collagen is produced. Heat of up to 60 degrees celsius is focused into the deep layers under the skin, which in turn creates a ‘micro injury’ to the tissue. This triggers a healing response which rejuvenates the area.
Two to three courses of treatment are sometime required. The results are fully visible within three months of final treatment and generally last two years
Radio frequency technologies can improve the appearance of saggy skin, and lift the brows. The treatment involves the use of radio waves to tighten the muscles below the skin on your forehead, creating smoother skin in the treated area. Low energy radiation heats the dermis layer, stimulating the production of collagen to help improve signs of wrinkles. The treatment is non-surgical, with results typically lasting for 24 months.
The use of bio-absorbable threads, such as Silhouette Soft, in the brow enables clinicians to reposition the sagging tissue causing the brow area to look heavy or tired. The area to be treated is numbed and threads are inserted to produce an instant lift immediately after treatment. In the following three months, the body starts to produce its own collagen in the treated areas, the new collagen will stay there way beyond the thread reabsorbing so results are maintained.
Treatment is frequently used to address brow ptosis (drooping), particularly in the tail of the brow and is also able to redefine the shape of the brow arch, creating a ‘Fox Eye’ look. There is little if any downtime and results last around 12-18 months.
Surgical brow lifts will rejuvenate and lift the brow, improving the appearance by raising the soft tissue and skin of the forehead and brow area. Treatment is performed in a hospital or an outpatient surgical facility as patients will require a general anaesthetic.
Brow lift techniques vary depending on your desired results. The specific technique your surgeon chooses will determine the location of the incisions and the resulting scars. Treatment typically takes 1-2 hours and downtime is around two weeks. In many instances, the results of treatment last 10 to 12 years. A surgical option is likely to be more expensive than a non-surgical procedure.
What is the best brow treatment for me?
There are a multitude of options to treat the brow, both surgical and non-surgical. I would always recommend you discuss a range of options with your treating clinician before deciding which would suit you best - based on your age, your lifestyle, as well as the cause and severity of your condition.
I find combination treatment options will yield the best results, depending on your age and level of degeneration of your brow and forehead area if you are seeking a non-surgical option.
• 30-40 years of age. For patients in this age group, non-surgical treatment with muscle relaxant toxins are typically sufficient to address brow concerns
• 40-50 years of age. Patients in this age group tend to experience a level of deflation to the brow, that responds well to a combination of treatments. I typically recommend a combination of toxin and Ellansé filler treatment
• 50 years + Patients in this group are most likely to benefit from repositioning of the brow. While surgical options will give the longest lasting results, many patients prefer a non-surgical route. For the age group I typically recommend a combination of treatments including toxins, Ellansé dermal filler and Silhouette Soft thread lifting to give an impressive, effective, non-surgical result.
Meet the Expert
Dr Sabrina Shah-Desai is a leading Ophthalmic Plastic Reconstructive and Cosmetic Surgeon based in the UK. She is internationally recognized as an expert in non-surgical and technologically advanced cosmetic treatments, being voted as one of the 100 most influential aesthetic practitioners in 2018.