Mini-brow lift vs. Botox: trying to save money

Lateral Brow Lift vs. Endoscopic Browlift

I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead - if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious

A youthful, feminine brow rests above the level of the orbital rim, which is the upper margin of the bony socket in which the eye resides. An aesthetically pleasing brow is somewhat arched laterally, and the lateral end or "tail" of the brow is higher than the medial end. It is quite common for the female brow to assume an essentially flat or horizontal orientation as a person ages.

If the skin and soft tissues lose enough elasticity with age and sun exposure, the lateral brow may even descend to a level below the orbital rim, producing a tired or even 'surly' appearance. The medial brow is relatively fixed in position and in most cases does not descend much, if any. In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.

While I used endoscopic browlift techniques for several years to treat brow descent, more recently I have transitioned to performing a limited incision lateral browlift that does not require the use of an endoscope. The relatively short incision is hidden behind the temporal hairline, and no incisions are required in the scalp directly above the eyes. The advantage is as follows: this approach allows me to not only redrape the lateral brow (conservatively!) in a higher position, but it also allows me to reposition the skin and soft tissues of the lateral periorbital area in an upward direction, producing a more complete rejuvenation of the periorbital area.

Rejuvenation of the brow by means of a lateral browlift will also, in most cases, improve the appearance of the upper eyelids. When the lateral brow is repositioned above the orbital rim, the vertical elevation may eliminate the appearance of wrinkled or 'crepey' upper eyelid skin. If the lateral upper lid skin is 'hooded' over the lateral corner of the eye, this improves as well. While upper blepharoplasty (upper lid skin excision) is often performed in concert with a lateral browlift, for many patients the upward positioning of the brow eliminates the need for skin excision.

BOTOX ® can also be administered just below the lateral aspect of the eyebrow to produce a temporary lateral browlift, which opens up and brightens the eyes. If you have been receiving Botox to lift your brows and are pleased with the results you may want to continue doing the same.

Michael Law MD

Raleigh, North Carolina

MissMe,

Do not expect a mini brow lift to have the same effects as Botox. Botox is very effective at paralyzing the muscles between the eyebrows (corrugators and procerus), the forehead muscle (frontalis) and crow's feet (orbicularis). A mini brow lift will not address all of these areas as effectively as Botox. My guess is that you would still end up needing some Botox to achieve the results that you were expecting. A mini brow lift does have some benefits, but is not without risk. You have an incision in your hairline and the surgeon must dissect around the nerves that control the muscles in your forehead. If you are in the right hands, you will likely have a nice result, but the result will most likely be different than what you are achieving with Botox.

I hope this is helpful.

David Shafer, MD

A mini-browlift is good for raising the outer part of your eyebrows. It will do nothing for the frown lines between your eyebrows.

To improve these frown lines with surgery, you need an endoscopic brow lift, or an open brow lift. The muscles that cause the frown lines can also be tackled through the upper eyelids.

But there is nothing "mini" about these operations. Also, many patients still need some Botox even after surgery for full correction of the frown lines.

So if you are happy with your Botox results, stick with that. In Manhattan, a treatment of 25 units of Botox should cost you $400 and should last 4 months.

Botox is not ideal to treat excess skin and eyebrow sagging. Botox is great to combat the repetitive motion of muscles and the wrinkles that it forms. As one ages, the first thing to happen is the formation of repetitive wrinkles around the eyebrows. The only way to treat this is with Botox or surgically removing the muscles. Endoscopic browlifts or removal of the muscle from the upper eyelids during a blepharoplasty is routine. The idea of calling something a mini-lift is a bit of hype. In my hands most lifts are mini. The incisions are small and the recovery is much better than for other facial procedures. As for the cost, the browlift procedure is permanent and probably costs anywhere from 3-5,000 dollars. Botox routinely costs $450 to $600 to get rid of these lines and must be done 2-4 times per year. With that math, the surgery should pay for itself in 2-4 years. Best of luck.

As the primary author of the first publication on the Botox browlift in Plastic and Reconstructive surgery, I have performed thousands of Botox treatments for both frown lines and to lift the outer portion of the eyebrows. A minibrowlift that targets the frown lines will cut the muscle (corrugator) and have a temporary effect on the lines. Eventually, the muscle does typically return to function, albeit after a longer period of time than the 3 month effect of Botox.

A temple lift is an alternative between a browlift and a Botox browlift in that it is less invasive than an endoscopic lift, less expensive, and lasts for years to lift the outer portion of the eyebrow, much longer than the effect of a Botox browlift. A temple lift, however, does not treat the frown lines.