Alternative to Eyelid Surgery and Botox?

I cannot use too much Botox in forehead because of droopy eyelids but I am not ready for Eyelid surgery. I would, however, like a smoother forehead and eyelid lift. Any suggestions?

Doctor Answers 9

Eye Lid Surgery/Botox Not Wanted, Is There an Alternative to Lift the Brow?

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Hi Suebb,

Your lateral eyebrow can be elevated by injecting filler (Restylane, Juvederm, your own fat) in the proper location and using the proper amount.

As others have stated, using the right amount of Botox in the appropriate muscles, a pharmacological eye brow lift can be attained.

Lastly, fractional CO2 laser treatments (Fraxel re:pair, Total FX ) can be used to take years off the appearance of the peri-orbital area (your eyes look younger) by tightening loose eyelid skin.

Choose your injecting physician carefully. Be well.

Dr. P

Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Botox can be given to women with " Droopy Eyelids "

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Botox can be given to women with droopy eyelids if it is given by a qualified surgeon who is very knowledgeable of the anatomy in this area. The treatments need to be made above the level of the first horizontal wrinkle, about 1.5 centimeters above the level of the brow. Matter of fact, botox in my practice is often used to raise the brow if delivered in the lateral brow. You need to find a plastic surgeon who sees complicated issues on a daily basis.

Having said this, the most appropriate treatment might afterall be a cosmetic eyelid or brow procedure. While you might think you might not be ready for this procedure, in the right hands, it is one of the easiest procedures that we do.

Phillip Chang, MD
Leesburg Plastic Surgeon
4.6 out of 5 stars 10 reviews

Eyelid Surgery vs. Botox

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Whenever the brows droop due to Botox it's a sure sign that surgery is needed. I am very weary of injecting Botox on women with laxity of the forehead skin and aging that will cause them to have brow droop and thus vision interference. It sounds like the most appropriate surgery for you would be a brow lift. This would flatten out the forehead and elevate the brows this giving you the result you're looking for. An endoscopic brow lift is not that invasive and has only about a week of social down time.

Forehead, eyebrow shaping

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Dear Suebb

You ask a very good question and many people have the same issue- Botox has been given and their eyebrows drop!!!!

It is important that the Botox is placed carefully to help lift the eyebrows- careful balancing which may take a couple of treatments. This can be combined with some shaping of the eyebrow to add volume and lift the eyebrow- fillers such as Retylane, Radiesse and Sculptra (recently approved for comsetic use by the FDA).

Thermage is a device that heats the deep layer of the skin- when combined with Botox- a significant lifting of the eyebrow will help maintain a fresh appearance.

With Warm Regards,

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

Consider a Microdroplet BOTOX forehead lift

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Dear Sue

Most doctors don't understand how to use BOTOX to modify the relationship between the forehead lifting muscles and the muscles at the eyebrow that pull the eyebrow down. Where your eyebrow sits is a tug of war between these two sets of muscles.

When doctors inject BOTOX into the forehead, this paralyzes the forehead. The results is a smoother forehead with fewer lines. However, as you have come to recognize, you pay a big aesthetic price: the forehead falls. This is because the muscles at the eyebrows are now unopposed. This causes the eyebrow to fall making the hooding so much worse. Sure a forehead lift surgery would counter this effect.

By the way, upper eyelid surgery is also not the answer. The heavy hooding causes the brain to lift the forehead. Cutting the upper eyelid skin with blepharoplasty decreases the signal for the forehead muscle to lift. As a result, after upper eyelid surgery, surprise, the eyebrow falls.

My answer is my patent pending Microdroplet BOTOX method. This technique solves a long standing problem: how to treat with BOTOX close to the eyelid without causing the upper eyelid to fall. This permits direct treatment of the muscles that pull the eyebrows done. No treatment is done on the forehead. This weakens the eyebrow depressors. The forehead muscle is no unopposed. The forehead muscle does not have to work as hard so the forehead lines improve. At the same time, the eyebrow comes up improving the hooding and creating a forehead lift effect.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox in People with Low Eyebrows

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The solution is to give small amounts of Botox and stay above the eyebrow by at least 1.5cm. This leaves a portion of the frontalis muscle (that lifts the brows) un-paralyzed and can lift up the brows to some extent.

You can also do Botox in the crows feet and extend a small amount to the lateral (on the side) eyebrow which will help lift the eyebrow and open the eye a little bit.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

BOTOX can help

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If you main issue is brow ptosis (drooping of the eyebrow). BOTOX can help. BOTOX is very effective at lessening or eliminating mild wrinkles in the forehead. You can usually accomplish this without necessarily causing the brow to drop as long you do it in the correct manner. It is true that you can acheive a chemical browlift as well, but usually this effect is very minimal 2-3mm at the most. Mild rhytids and large pores can also be addressed by fractionated laser resurfacing as well.

Samson Lee, MD
Seattle Facial Plastic Surgeon

Brow lift with Botox

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If you have excess eyelid skin and do not want to have surgery, you may want to consider trying Botox to produce a chemical brow lift. This is moderately effective and really depends on your anatomy. However, there are muscles that work together to keep your brow in place. If the muscles that are pulling it down are blocked with Botox, then the brow may lift a little and stretch out the skin that is on your upper lid. Good luck.

Smoother brow and eyelid ift

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It sounds that you have a case of "lateral brow ptosis", where the outer "tail" of your eyebrow is starting to drop; this is a very normal condition and occurs earlier in individuals who are born with narrow eyelid folds. When a Botox injector doses the product too low on the lowest horizontal line, the toxin blocks your ability to elevate the brow and you feel heaviness of the eyebrow or a flattening of the shape, making you appear "tired".

I would suggest a) that you ask your injector if (s)/he knows how to produce a chemical "browlift", by blocking the muscles responsible for depressing the brow; b) discussing whether a synergistic combination of a hyaluronic acid filler, such as Restylane or Juvederm Ultra and lower dose Botox would be beneficial in your case. Small amounts of filler can supplement the effect of Botox by softening the lines and elevating the tail of the brow.

Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 59 reviews

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.