Published August 15, 2020 By Dr. Adam Lowenstein

Botox has long been considered a sort of wonder-drug for the reduction of dynamic lines and wrinkles. Initially approved by the FDA to treat frown lines, Botox used has expanded significantly. It is now commonly used to reduce the appearance of crow’s feet, the lines that you see at the outer corners of your eyes when you smile or laugh. Some doctors use Botox to treat a tensed masseter muscle at the jawline. Some use it to stop excessive sweating. Dr. Lowenstein uses Botox both cosmetically and diagnostically, to ease the signs of aging and to uncover the source of migraines. Of all the wonderful things Botox can do, what we want to discuss here is how Botox lifts the sagging brow line.

The real question about the Botox brow lift is whether or not this injectable treatment actually lifts the eyebrows. It doesn’t. Not directly, anyway. The way that Botox works on the brows is no different than how it works on frown lines and other dynamic wrinkles; it stops muscle movement.

The eyebrows sit between two sets of muscles; the orbicularis oculi and the corrugator muscles, which pull the eyebrows down and inward, and the frontalis muscles, which pull them upward. These muscle groups work in opposition and, when one group is stronger than another, the eyebrow gets pulled in a certain direction. This is where Botox comes in. As the muscle-relaxer, Botox temporarily weakens the pull of the stronger muscle group. In this case, the orbicularis oculi and corrugator muscles are relaxed so the frontalis muscles can work more effectively at holding the brow line in a higher position.

As popular as Botox is, there is a potential problem with this solution for a sagging brow line. It assumes that a person has strong frontalis muscles. Getting Botox injections may be the only way to confirm the strength of this muscle group to do a decent job of lifting the brow when unopposed. Contrary to common belief, getting more Botox won’t correct the problem.

When Botox Doesn’t Work

When the brow line is just too far down to restore to a height at or near the upper orbital rim using Botox, patients can consider a surgical brow lift. This procedure can often be performed endoscopically using multiple small incisions rather than one long one. In addition to precisely repositioning the muscles that hold the brow in place, a brow lift achieves results that can last many years, versus results that last months.

A lowered brow line does not have to be a defining facial feature. Contact us at 805.969.9004 to schedule a consultation in our Santa Barbara office.

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