I have a naturally low brow and am concerned with the excess skin and hooding (hereditary) that began to appear in my late 30's (I am currently 45 y.o.) A number of board certified cosmetic surgeons have agreed I need a brow lift in conjunction with an upper bleph. Aware that a brow lift will alter my appearance, I want to go very conservative with the brow lift. Botox has worked well, but I'm looking for something longer lasting. Thank you in advance for your advice.
Which is Better, Endoscopic Brow Lift or Ultherapy, to Lift Brow Position 3-5 Mm?
Doctor Answers (11)
Beware of brow lifts! Focus on the lateral hood!
Be very careful when asking for a brow lift, you might get it. If you look up brow lift results in published papers and before and afters you will see that many surgeons successfully lift the brow. Unfortunately a true brow lift makes patients look scared or surprised! It is almost never necessary to elevate the medial third of the brow. Many women actually benefit aesthetically from a slight lowering of the medial third. On the contrary, there are few women even at your age that would not benefit from elevation of their lateral brow. The reason for this is probably not what you think. Much more important than the brow positionand shape is the infra brow skin. If you look at yourself in the mirror you will see some bunching of skin under the brow next to your eye and a flat shape. I call this the lateral hood. The only kind of brow lift that I typically perform I call a lateral hood lift. If you gently pull up on your forehead skin above the lateral brow, you will see that a very subtle elevation makes you look younger. This is mostly because it cleans up the lateral hood. It is usually necessary to also restore brow volume at the same time as a lateral hood lift to create a beautiful rejuvenated shape. I hope this helps!
Forget about energy based methods such as Ulthera- risk of difficult to fix complications and at best unnatural results!
All the best,
Rian A. Maercks M.D.
Conservative brow lift
The best option is either an endoscopic brow lift or a temporal brow lift. Ulthera is a bit of a wild card and the long-term results are just not there.
Endoscopic Browlift vs. Ulthera
Great question: The two main non-surgical browlift approaches are Botox and Ulthera. They work very well in the appropriate candidate. Endoscopic browlift is a more powerful browlifting method but for more advanced drooping of the brows. We have combined volume restoration with Ulthera to address the true cause of brow drooping with great success in early to moderate aging changes. For more advanced changes of the brows that also have eyelid hooding, then endoscopic browlift with upper blepharoplasty will work better.
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Brow lift options
There are many different brow lift options available to a patient. The hairline must be addressed. The level of the medial brow and lateral brow needs to be considered as well as the function of the corrugator, procerus, and frontalis muscles prior to making any decisions regarding a brow lift. 3-5 mm is a nice conservative brow lift. The upper blepharoplasty can also be done at the same time.
Ultherapy will not raise brow position; you need a forehead lift to do that!
Let me repeat: Ultherapy will not lift your brows. Only surgery will give lasting results, and most all forehead lifts and many eyelid surgeries tend to be once-in-a-lifetime procedures.
A proper assessment of your upper eyelid excess skin and "hooding" will tell you how much of this apparent excess is actually due to your brows being abnormally low (at or below the orbital rim), and how much is true excess upper eyelid skin. For most patients, it is a combination of both, making a forehead lift (same as browlift) plus upper lid blepharoplasty an appropriate recommendation.
A hairline (trichophytic) browlift will preserve and actually lower your hairline (if that is a concern); otherwise, a bicoronal incision will leave a scar hidden entirely within your hair (which does not have to be shaved), best access to the orbital rim periosteum (which needs to be released for optimum aesthetic results), and access to remove the corrugator supercilii and procerus muscles, which gives you the added benefit (if you wish--this is an optional step that most of my patients request, and I add at no additional charge) of giving a "permanent Botox-like effect" in eliminating frown lines. The rest of your forehead animation (raising your brows, for example), and sensation is left normal. The brows are elevated permanently into a relaxed, alert, youthful (not "surprised" or "startled") position and your hairline is raised by only the same few millimeters.
A well-performed endoscopic forehead lift can accomplish the same things, but may not permanently lift the brows as effectively (since no skin is removed, and the tightening is dependent upon hooks, screws, or "wrinkling up the forehead and scalp" and trying to make sure it heals in its new elevated position). In years past this was infrequently and poorly accomplished; now, there are many expert endoscopic brow-lifters available. The only drawbacks are that an endoscopic lift may take longer time in the operating room to do an equivalent job, and of course, the expensive equipment. Guess who pays for that?! Also, the scars are right at the hairline, and can be more visible than "advertised" since all the work must be done through these holes, which inevitably stretch, become irritated, or lose the hair due to damage to the hair follicles.
Many experienced plastic surgeons who have trained to do endoscopic forehead lifts, but also were trained previously in bicoronal or trichophytic incisional approaches to forehead lifting, have preferred to continue with the more efficient, more effective, less costly (time and equipment), and better access (?better job, including the frown muscle excision) NON-endoscopic forehead lifts! A properly performed incision and closure leaves a long, but nearly invisible scar completely hidden in your hair, or at your hairline if you have a high forehead. Endoscopic lifts are newer, but not necessarily better!
BTW, I am concerned when you say you are seeing "board-certified cosmetic surgeons." Check the credentials of these doctors--is he or she an American Board of Plastic Surgery-certified plastic surgeon? Not just a "board-certified" surgeon, since there are many "real" boards that have nothing to do with plastic surgery, as well as a few "bogus" boards. See my article on my About page titled: "Why Board Certification is Critical When Choosing a Plastic Surgeon" for more information. The American Board of Cosmetic Surgery is NOT an ABMS member board. You need to see an American Board of Plastic Surgery-certified plastic surgeon, or a board-certified facial plastic surgeon (ENT), NOT a dermatologist or family practice or ER physician who has "decided" to call him or herself a "cosmetic surgeon" without complete surgical training.
Good luck and best wishes!
Ultherapy vs Brow Lift
The answer for you, because of your criteria of wanting “something more permanent,“ is easy. You need a brow lift. Almost all of full brow lifts today are done endoscopically. This, when done well, will not alter your appearance, only enhance it, and will be permanent. Treatments like Ultherapy, to my knowledge, have never, using controlled blinded studies, been shown to be more long lasting than a number of months.
Endoscopic Brow Lift & Other Options
A surgical brow lift will provide a long lasting result as opposed to Botox injections. Your hairline position should be evaluated when deciding what technique is best for you because the endoscopic lift will elevate your hairline. A trichophytic hairline incision, which we developed many years ago, will maintain or improve the hairline position if that is necessary.
Endoscopic browlift would give you the desired results
Ultherapy or Surgical Brow Lift: Which is better?
As I do both procedures, I can tell you without hesitation that surgery is better. I can achieve greater lift and more precision with a surgical approach. This is not the decision that you need to make, however. What I tell my patients is that there is a trade-off with either approach. Surgery will give you better results but has more risk of complications and higher cost. Ultherapy is the opposite; less risk and cost but lesser results. You just need to decide which side of the equation is more important to you.
Brow Lift Options
Endoscopic brow lifts are an excellent option to acheive a moderate amount of brow lift - often providing just a little more than can be achieved with Botox. Be aware that getting a brow lift will not eliminate the need for on going Botox injections to achieve a smooth, unstressed brow.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.