As we age, the soft tissues of the brow descend, just as they do in the face. As this process progresses, this ptotic soft tissue can begin to crowd the upper eyelid skin, and actually reduce the patient's visual field on upward gaze.
To compensate for this, patients often unconsciously fire their frontalis muscles to lift this sagging tissue up, and in so doing improve their field of vision. However, this constant action of the frontalis muscle can produce significant transverse wrinkles across the forehead.
Many people think that these lines can be adequately treated by botox. It is true that the botox may soften the wrinkles somewhat, but, in fact, because botox weakens the frontalis muscle, it's use in a middle-aged patient with significant brow ptosis will only aggravate this problem.
The definitive treatment for brow ptosis is a brow lift. In our clinic, we perform an endoscopic browlift with endotine fixation, which produces a significant and long-lived elevation of the brow, while leaving small scars that are hidden behind the hairline.
This procedure will also dramatically improve the transverse forehead wrinkles, and with some additional dissection, the wrinkles that make up the "frown lines" can also be significantly softened, which can result in an even more dramatic improvement for the patient. The take home lesson here is that it is very important to understand the etiology of the wrinkles you are treating, and to know when something other than botox or fillers is needed to adequately address the underlying anatomical issues.