Permanent Solution for Forehead and Eye Wrinkles?

There are alternatives to Botox for wrinkles in the upper face. Brow lifting can help with some of these wrinkles, but surgical brow lifts usually do not eliminate forehead wrinkles long-term (even with aggressive treatment of the forehead muscles). Certain resurfacing procedures (like lasers or deep chemical peels) can help to improve forehead wrinkles, but even still may not eliminate them altogether.  Unfortunately, Botox is still often needed even with some of these procedures. These procedures could potentially increase the effectiveness of the Botox or allow for lower dosing to be used, but be wary of surgical options that promise to remove all wrinkles in the upper part of the face.
All the best,

There’s no permanent solution for
forehead and eye wrinkles.  
Even surgical procedures that are commonly used to address these issues
don’t provide a permanent solutions. 
Facial rejuvenation procedures frequently set the clock back, but never
stop it from ticking.

Although brow lift surgery can
occasionally treat forehead wrinkles by dividing the
procerus and corrugater muscles, there’s really no surgical procedure that
effectively treats crows feet.

Botox represents the best available
option for treating crows feet. 
When brow descent is present, a brow lift can be performed that
simultaneously lifts the brow and divides the procerus and corrugater muscles.  In some cases elevation of the lateral
brow may help crows feet as well.

Consultation with a board certified
plastic surgeon would be an appropriate next step.  This surgeon can advise you regarding the best option for
achieving your aesthetic goals.

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!

All the best,

Rian A. Maercks M.D.

As stated there are options available such as Forehead lift with or wtihout corrugator resection. Brow lifts can be achieved using at least 5 different approaches

transblepharoplast (throught the eyelid)
direct (above the brow)
through an existing line in the forehead
in front of the hairline
in the hairline (coronal)
endoscopic
limited incision (temporal)

Approaches can pass over the bone, under the muscle or under the skin.
The best option for your husband will be determined after consulting with a plastic surgeon.
Other alternatives include the use of radiofrequency destruction of the temporal branch of the facial nerve. Although we thought this would be permanent, it typically resutls in a long term correction (1-2 years).

Botox is a good treatment to relax frown lines, brow lines and crow's feet. Patients seeking a longer lasting result may be a candidate for surgery. The frown lines can be softened by surgically removing some of the muscle called the corrugator. Horizontal lines may be from the need to hold up ones brow to keep drooping eyebrows or overhanging eyelid skin from leaning on the eyelashes. in that case, a browlift or blepharoplasty is the surgical alternative. I suggest you seek a consultation with a specialist in surgical facial rejuvenation to see what is best for you.

One of the goals for a forehead lift is to soften the forehead wrinkles caused by the frontalis muscle. When patients raise their eyebrows, furrowing occurs in a horizontal fashion across the forehead. If the muscle is very strong and patients continue to contract that muscle, dermal atrophy will result. Botox is a good alternative as a conservative measure, but when that fails or patients do not wish to undergo Botox any longer, a forehead lift can be performed to soften the frontalis muscle depending on what the patient’s goals and desires are. The frontalis muscle itself is thinned and refined to weaken it.
The goal for an upper blepharoplasty surgery is to remove excess skin on the upper lids with a small amount of fat removal on the inner corners of the eyelids.

Forehead lines are caused by the shortening of the underlying Frontalis muscle lifting the brows upwards. If the brows are low, then a brow lift would greatly place the brows just at the upper rim of the orbits making constant upward pulling unnecessary, it will refresh the forehead and smooth it. The result would last many years.
A Blepharoplasty will not smooth Crow's feet wrinkles and Botox remains a great modality for this purpose.
Dr. P. Aldea

Botox works by weakening the active function of muscles. A surgeon can permanently disable or remove the same muscles to produce a long-lasting effect especially if the Botox has been proven to produce the results he wants without any disadvantage. The wrinkles of the forehead are more easily eliminated while the ones around the eyes themselves are more difficult since some of these same muscle are necessary to close the eyes.

The surgical clipping of the corrugator and procerus muscle does diminish forehead movement for a longer period of time than botox injections. Even the surgical procedure doesn't always last forever though, but it is a good thing to try for the really expressive forehead with lots of wrinkling.
The crows foot area, on the other hand, is much more difficult to treat surgically and my best advice would be to continue botox for that area. Your husband should consult a plastic surgeon for a treatment plan tailored to his needs.

The corrugator muscles can be interrupted in the forehead if the wrinkles are between the eyebrows. A browlift can be be done simutaneously if brow ptosis is present. The laugh lines lateral to the eyes can be improved with the browlift. If the wrinkles lateral to the eyes are present without animation, they can be softened with filler injections.