When your brows start to sag, it can be hard to know whether Botox or surgery is the answer. According to Encino, CA plastic surgeon George Sanders, MD, who has practiced in Los Angeles for decades, it all starts with pinpointing which part of the brow is the problem. Ahead, he breaks down the options, from injections to surgical lifts.
First, figure out what’s actually bugging you
Before he recommends anything, Dr. Sanders asks one simple question: What’s bothering you? “Low brows” can mean a drooping tail, a heavy center, loose skin or a shape that just looks off, and each one calls for a different approach.
Placement and tilt matter, too. In women, the inner brow typically sits at about the level of the bone above the eye (the supraorbital rim) before arching gently outward, while men typically have straighter brows. Inner brows that slope down can read as angry, he says, while ones that tilt up can look worried or perplexed. One quick check: If your brows sit below that bony ridge and you also have a lot of extra skin on your upper lids, it’s worth asking whether the brow is contributing to that heaviness.
That said, Dr. Sanders is quick to call the textbook “ideal” brow a theoretical construct, and plenty of his patients have always had low brows and love them. His favorite way to get to the heart of what you want is to have you bring in photos of yourself from years ago. He’ll take new ones at your consult and compare the two. Sometimes, he says, patients realize they’ve had those brows all along and aren’t that concerned after all. And the goal is never an obvious result. “I think the worst thing is to have something that looks unnatural, that makes it look as though you’ve had something done,” he says.
Low tail? Start with neurotoxin
Here’s why the outer end of your brow tends to droop: According to Dr. Sanders, the muscle that lifts your brows only supports the inner two-thirds, leaving the tail with less support. Meanwhile, the muscle around your eye pulls it down every time you squint.
That’s why, for a low tail, Dr. Sanders starts with a neurotoxin such as Botox at the corner of the eye, which relaxes the muscle doing the tugging and can give the tail a little lift. For a heavy center or the vertical “11” lines between your brows, he treats the muscles in that area instead.
The game plan is simple: Try it and see. If you like the result, great. If the improvement isn’t enough, he may discuss surgical options. (Give it about two weeks to see the full effect.)
When it might be time to consider surgery
If Botox isn’t enough, here’s which surgery he recommends for which concern:
Bunched skin at the brow tail, especially after a facelift: Dr. Sanders may recommend a gliding brow lift. He says the more vertical direction of some facelifts can leave skin bunched near the outer brow. The procedure repositions that skin, with small sutures placed through it to hold it in place as it heals. The sutures come out after about five days.
Very low brows with deep creases in the center: The pre-hairline forehead lift, which he says can deliver his most dramatic results. He says it can soften a scowling expression, with creases becoming less pronounced as the muscles weaken. The incision sits along the hairline, where the scar may be less noticeable, though numbness and itching are common and usually fade.
Extra skin just above the brow: A direct brow lift is quick and holds up well, Dr. Sanders says, though it does leave a scar above the brow. Brow tattooing may help camouflage it.
Dr. Sanders generally tells patients to allow about one to two weeks before they feel comfortable being seen socially, though recovery and clearance to exercise depend on the procedure and the individual. If heavy upper lids are also on your list of concerns, ask about doing both at once. Dr. Sanders combines a brow lift with an upper eyelid lift in about 90 percent of his cases, and says the combined procedure generally has a similar recovery timeline.
The reality is that not everyone is a candidate
Whether a lift makes sense also depends on your anatomy. If you’ve had low brows since childhood and the skin isn’t loose, Dr. Sanders says these approaches may offer limited improvement. And a high forehead can work against an endoscopic lift, he says, because the distance between the incision and the brow can make secure fixation more difficult.
The TL;DR:
You don’t need to arrive at your consultation knowing which treatment you want. Start with what bothers you and let that guide the conversation.
