As we age, many of us experience a sagging and hooding of the upper eyelids over time. This sad tired look is a result of two different processes. First, the upper lid itself starts sagging and covering up the eyes. In much older patients, this can actually partially shut the eyes and diminish their vision significantly. The other contributing factor is that the forehead also start sagging, and with it the eyebrows take a lower position and literally push down on the upper eyelids, aggravating the condition even further.
For those who prefer non-surgical options, one of the most effective treatments can be a series of radio frequency treatments with the Refirm ST. This gentle heat treatment helps tighten the forehead skin above the eyes and eyebrows, thus pulling up the brows toward their original position. As a result, the upper lids follow. The look of the eyes becomes more open and less hooded and, in some cases, any obstruction of the vision caused by the sagging skin can improve.
These are painless treatments that are performed every two weeks until the eyebrows reach the optimal position. A non-surgical browlift can also be helpful for those patients who have one eyebrow higher than the other. In this case, we treat the lower situated eyebrow until it becomes more symmetrical with the other side.
A non-surgical browlift can also help patients who have had an unfortunate drop of their eyebrow, due to an unsuccessful Botox treatment with another doctor. For these patients, I often recommend Refirme ST treatments, which can help lift the eyebrow and correct the drooping of the upper eyelid. Refirme ST can be repeated until the unwanted effect wears off.
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Can Botox be used to lift the eyebrow?
Yes. Botox can be injected into the outer end of the eyebrows to provide a more open look to the eye. However, the Botox treatment only lifts the outside 1/3 of the eyebrow. On the other hand Refirme ST works to lift the entire brow by tightening the forehead above. One can always provide a little extra lift by using Botox to the lateral brow area. Keep in mind that Botox has to be repeated every 3-5 months to be of use.
I heard that some doctors use filler to provide an eyebrow lift, is this a good option?
Fillers can be used alone or in combination with Refirme ST and Botox to create a more lifted eyebrow look. The filler simply creates a forward projection of the eyebrow and creates the look of a bit of a lift. However, this will not be effective in making the eyes look more open without the help of Refirme ST and/or Botox. Fillers, same as Botox, are temporary and have to be repeated periodically.
When would you recommend a surgical brow lift?
Any patient who has a very severe drooping of the forehead and the eyelids, with significant vision disturbance, may be a good candidate for surgery. It’s possible to try to lift the forehead with the Refirme ST and hope it will solve the problem. If not, then the patient can consult with a plastic surgeon who specializes in the treatment. This may be the solution for some older patients with less skin elasticity, who respond less readily to the non-surgical tightening option with the Refirme ST.
What about Ultherapy? I heard if can help.
Ultherapy utilizes ultrasound waves to try and treat the skin. It is usually painful, and doesn’t provide an immediate lift same as the pain-free Refirme. A patient came to me after their eyebrow dropped due to an inadequately performed Botox treatment, and the treating doctor offered them Ultherapy. The patient had to attend her son’s wedding the next weekend and was told that the Ultherapy will tighten their skin in the next few months. In her case, Refirme ST provided an immediate lift and the patient looked great in the wedding photos. Individual results will vary, of course, depending on the condition of the skin and responsiveness to treatment.
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