There are several differences between Botox injections for brow elevation and a formal brow lift. Botox injections can be performed in an office setting in about 5 minutes. In order to elevate the eyebrow using Botox, the injections are made in the higher portion of the crow’s feet just below the tail of the eyebrow and in the area at the top of the bridge of the nose just below the area between the eyes. The reason that these two injection locations are necessary is that in order to elevate the eyebrow with Botox, the muscles that depress the brow in the middle and the ends need to be weakened. In the middle portion of the eye brow those muscles are called the procerus muscles and in the lateral portions of the brow those muscles are the orbicularis oculi muscles. It only takes about 16 units of Botox to effectively elevate the brow. There are caveats to this procedure. The first is that the effects of Botox are only temporary, usually lasting anywhere between 3 1/2 to 41/2 months. The other issue is that the elevation in older individuals is really quite modest.
A formal brow lift procedure is a true operative procedure. The procedure can be performed under IV sedation or general anesthesia, which I use when other cosmetic procedures will be completed at the same time. There are several ways of performing the procedure. I prefer the use of endoscopes when the patient situation is appropriate. I like to avoid large incisions in the scalp when I can as this can lead to prolonged healing, scalp numbness, and scarring. In females with an already high hair line, an incision in the first few hairs of the hairline will provide excellent camouflage to the incision, and allow me to not only elevate the brow appropriately but also shorten rather than lengthen the hairline. In men, special consideration must be given to the approach to the brow lift. Male pattern baldness or even thinning of the hair will lead to exposure of the incisions even if well placed and well healed in the hairline. I use an approach through an upper eyelid incision in men. The brow lift procedure is not a one size fits all procedure. When performed properly, the brow lift can be used to customize the appearance of the eyebrow. The sequela of a brow that is lifted too high, giving the patient a surprised look can be avoided. Recovery from a brow lift is usually about a week but the results are long lasting and predictable.