As we age, skin begins to lose its elasticity and we begin to lose fat volume and structural support in the face. Over the years, muscles and skin in the brow and forehead may begin to descend and lose volume, creating horizontal creases for some, and a heavy or drooping brow for others. These changes create furrows between the eyebrows, weight in the upper eyelids, and may add to an aged, tired, or agitated appearance.
While some nonsurgical treatments, like botulinum toxin injections, can help soften and even subtly re-contour the brow tissue, their effect is limited. For the right patient, forehead or brow lifting may be a more permanent solution to a more relaxed and youthful appearance.
Patients who have a "heavy" forehead or brow accompanying drooping or deflated eyelids may benefit from combined upper eyelid blepharoplasty and forehead/brow surgery. When combining eyelid and eyebrow surgery, if each is performed in the correct proportion, a synergy can be achieved, where the whole result is greater than the sum of the parts. Patients who have fat loss of the superior eyelid may additionally benefit from simultaneous upper eyelid fat transposition, or fat grafting or HA filler injection.