Eyebrow Ptosis: Causes, Prevention, and Treatment

By Dr. Reza Akef, MD, CCFP-EM
Medical Doctor (Canada)
Assistant Clinical Professor, McMaster University

A Botox brow lift is a type of procedure that elevates the height of your eyebrows. The muscles which are responsible for balancing the eyebrow in its place include: the Frontalis muscle on the upper side of eyebrows pulling the skin of the brow upwards; and the Orbicularis oculi muscle inferior to it, pulling the skin of eyebrow downwards. 

In order to make any kind of changes to the condition of the eyebrows by injecting Botox, it should be done on these muscles. Botox dose relaxes underlying muscles to smooth your skin on the outside, and relaxes the muscles between the brows. For example, if in a Botox injection procedure we need to pull the lateral part of the eyebrows higher than their usual place, we must inject the Botox through the lateral fibers of orbicularis muscle. On the other hand, if we need to pull the lateral part of the eyebrows lower than their usual place, the Botox should be injected through the lateral fibers of Frontalis muscle. The same thing can be done for the medial part of eyebrows, but you must consider that unlike the lateral part—which we only had orbicularis oculi muscle as the depressor of the skin in this area—the Depressor Supraciliary, Procerus muscle, and the Orbicularis oculi muscle has lesser importance in depressing the medial part of eyebrow skin. 

The amount of lift you get will vary depending on your age and tone of the active muscles that are left to pull up the now-relaxed muscles. Botox is a nonsurgical procedure. It is different from a traditional brow lift, which is a type of cosmetic surgery that involves incisions and the removal of your skin. Brow ptosis is also a potential complication after upper eyelid blepharoplasty. 

Like the incidence that might happen for the eyelid, in brow ptosis, we also have the client complaining about the lowered position of the eye brow, the hooding of eyelid and a heavy feeling. To avoid this kind of incidence, first, we should be aware that the clients with pre-existing brow ptosis and with a functioning frontalis when opening eyes are not suitable for Botox injection. 

And of course, the proper techniques: the doctor should pay close attention to factors such as the dose of botulinum toxin, concentration, direction of the needle, location and velocity of the injection, position of the doctor and patient, and position of the hand.

For those clients that unfortunately have this problem, we have 3 ways of treatment. First of all, to inject glabellar complex if not injected originally in an attempt to elevate glabella. Second way is simply to over exaggerate frontalis muscle. And there is also a last way, to not to use any kind of antidote and just wait for the muscle to gain its activity back.

CBAM provides both basic and advanced botox and filler training courses to all licensed healthcare practitioners (including: cosmetic nurses, nurse practitioners, registered nurses, doctors, dentists, and physicians) looking to expand into the field of aesthetic medicine.