Brow lift or hooded eyelid lift? Should I use botox or juvederm? (Photo)

Question

Hello, I am wearing bangs all my life and really it is not a trend many years and I realize that I look not pretty at all without bangs but I want to get rid of bangs so much. I just figured the problem is in my eyelids or/and eyebrows. I think I need a lift either in my hooded eyelids (or maybe a surgery?) and/or a brow lift somewhere in order for my face to look attractive without bangs. Help me please to understand what needs to be corrected... I attach pictures. I appreciate any comments.

Brian S. Biesman, MD · Answer

Thank you for your question.  You do have a somewhat higher forehead and relatively low brows.  Elevation of the eyebrows alone may be helpful.Before making a specific treatment plan, I would meet with an expert in both surgical and nonsurgical techniques to discuss your concerns and goals face-to-face.  A review of old photographs taken when you were younger may be helpful as well.

Young R. Cho, MD, PhD · Answer

Thank you for your question.  Shaping the brows is one my favorite parts of using Botox.  It requires a very detailed understanding of the underlying anatomy as well as assessing each individual while they are animating their brows.  By carefully placing Botox in the muscles that depress the brow, you can cause the brow to rest and relax in a lifted position.  There are limits to how much you can lift, and for some surgery is better option.  Incorrect assessment or placement can also lead to the reverse effect, so overall technique is critical.  You can also shape the brow different.  For example, you can raise the tail of the brow vs creating a raised arched brow vs creating a raised horizontal brow.  It depends on the individual's desired brow aesthetic goals. I would consider this a very advanced technique so I would query your injector on their experience in this area.  
As far as how many units may be needed, this also depends on which part of the brow you want to correct.  For the inner brows, you may consider ~20 units (same as the frown line treatment).  For the middle or outer brow, I generally use up to 5 units on each side.  
You may also want to consider adding fillers such as Juvederm to shape and raise the brow.  Combining the two products can work synergistically together.

Thomas Buonassisi, MD · Answer

Thanks for sending in your photos. You look great. I agree that your brows may be slightly lower than you like. This contributes to lateral "hooding" of your eyelids. This can be improved by gently elevating your brows and removing some of the extra eyelid skin. You may not need both. Botox can help elevate the brows but probably not enough to correct the lateral hooding.   Good luck!

Raymond E. Lee, MD · Answer

Hi and thanks for posting your photos and concerns. I believe the brows are slightly down and there is excess upper eyelid skin especially on the lateral part. Both of these reasons contribute to the appearance of lateral "hooding."  Therefore a brow lift or eyelid lift (blepharoplasty) or both would help. Even Botox itself would help you get lateral brow elevation and may be worth trying first as non invasive procedure and see how you like the look before committing to a surgical procedure. You need to consult a surgeon familiar with these techniques to help guide you in the right decisions. Best,

Fred G. Fedok, MD, FACS · Answer

Sometimes moderate but effective procedures are the answer.  You should be evaluated by an experienced surgeon.  A modest blepharoplasty + a well planned trichophytic browlift may be your best answer.  Although a mild browlift can sometimes be accomplished with botox I am not confident that would create a sufficient improvement.  Best of LuckFred G. Fedok, MD

Toby Mayer, MD · Answer

A brow lift done with an Irregular Trichophytic incision would help raise your brows lessen the upper eyelid skin and make you look more alert. See a very experienced surgeon with this technique for the best results.

William Portuese, MD · Answer

The Photographs demonstrate slightly low eyebrows with the patient's right eyebrow lower than the left. A conservative eyebrow lift could help not only lift the eyebrows, but makes them even. Hooded upper eyelids are also present which can be addressed with a simple skin excision to give more upper eyelid show. To understand the differences between the 2 procedures, please see the link and the video below our eyelid and brow lift  photo  gallery

Richard W. Fleming, MD (retired) · Answer

I suggest you use the Irregular Trichophytic Hairline Incision technique that we described many years ago to lift your brows and lower your slightly elevated hairline.This will give you a more rested look and improve facial balance.

Sheldon S. Kabaker, MD FACS (retired) · Answer

Your whole face looks better when you smile with (or without) bangs.Upper lid blepharoplasties are what you likely need to make your eyes look more attractive. See an experienced facial surgeon.

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