What is Drooping Eyebrows and How is it Treated?

Brow ptosis is a condition that typically arises from aging, genetic factors, or prolonged sun exposure. This condition can make the individual appear tired or unhappy, and in more advanced cases, it may also affect the field of vision. Among the treatment options, the most common method is brow lift surgery. This procedure aims to reposition the eyebrows to a more youthful and aesthetic position. Surgical methods may involve direct skin removal as well as endoscopic techniques that leave fewer scars. The choice of method depends on the patient’s facial structure and expectations. Brow ptosis is an aesthetic and functional issue that can be resolved with treatment.

What Is Brow Ptosis and Why Does It Occur?

Brow ptosis is the condition in which the eyebrows descend below their normal position. It usually arises due to aging, genetic factors, or muscle or nerve issues. This condition can lead to both aesthetic and functional problems. The main causes of brow ptosis are:

• Aging

Loss of skin elasticity and weakening of the tissues in the forehead area, causing the eyebrows to move downward.

• Genetic

Being born with naturally low eyebrows.

• Facial nerve palsy

Loss of function in the nerves that control the forehead muscles.

• Trauma

Damage to the muscles or nerves from impacts to the eyebrow area.

• Muscle weakness

Insufficient strength of the muscles in the forehead and around the eyes.

• Diseases

Conditions such as myasthenia gravis affecting the muscles that lift the eyebrows.

Brow ptosis can make an individual appear tired, unhappy, or older. In advanced cases, it can narrow the field of vision and make daily activities more difficult. While brow ptosis can be seen at a young age due to genetic reasons, causes like trauma and facial nerve palsies may lead to a sudden onset. This situation can affect a person’s quality of life and increase the need for treatment.

How Does Brow Ptosis Affect Vision and Appearance?

Brow ptosis can affect both visual function and facial aesthetics. When the eyebrows droop downward, they can press on the upper eyelid and narrow the field of vision, making daily life more difficult. At the same time, it creates a noticeable change in facial expression, causing the individual to appear older, more tired, or sadder than they actually are.

Effects on Vision:

• Narrowing of the upper visual field
• Pressure and drooping of the eyelids
• The eyelid descending onto the eyelashes
• Involuntary raising of the eyebrows to correct the visual angle
• Needing to tilt the head backward
• Pain and tension in the neck and head area

Aesthetic Effects:

• An older and more tired appearance
• Creating a sad facial expression
• Changes in expression due to eyelid drooping
• Loss of self-confidence in social interactions
• Even if one feels energetic and happy, projecting a different impression from the outside

Brow ptosis is not only an aesthetic issue but also a problem that affects daily life quality. Particularly in advanced cases, it can negatively affect a person’s lifestyle and overall health. If left untreated, both visual problems and aesthetic concerns may progressively worsen. Therefore, appropriate treatment methods can provide improvements both functionally and aesthetically.

Which Surgical Procedures Are Available to Correct Brow Ptosis?

Various surgical methods are available for brow ptosis. Each method has its own advantages and way of application. The choice of which method to use is determined by the patient’s needs, the severity of brow ptosis, and the facial structure:

• Direct brow lift
• Endoscopic brow lift
• Mid-forehead lift
• Hairline brow lift
• Temporal (lateral) brow lift
• Internal brow fixation
• Combination techniques

These surgical methods not only meet aesthetic expectations but also help solve functional problems. For example, more invasive methods may be preferred for severe drooping affecting the visual field, while minimally invasive techniques may suffice for mild ptosis. The postoperative process may vary depending on the method; factors such as recovery time, visibility of scars, and the permanence of results are included in this consideration.

How Is the Appropriate Surgical Technique Determined for Brow Ptosis?

In treating brow ptosis, the appropriate surgical technique is determined by the patient’s individual characteristics, the severity of the brow ptosis, and the desired outcome. During this process, the surgeon conducts a detailed evaluation to choose the most suitable method.

Mild brow ptosis:

• Eyelid surgery
• Brow suspension procedures

Moderate to severe brow ptosis:

• Endoscopic methods
• Direct brow lift

Factors related to anatomical structure:

• Forehead structure
• Skin elasticity
• Hairline

Methods preferred based on expectations:

• Procedures that leave minimal scarring for aesthetic results
• Surgeries aimed at expanding the field of vision

When planning the surgical procedure, the specialist also considers the patient’s overall health status. Bleeding disorders, diseases that could affect the healing process, or previous facial aesthetic surgeries can be decisive in selecting the surgical method. Additionally, providing the patient with detailed information about possible complications after the surgery ensures an informed decision-making process. The correct technique selection aims not only for an aesthetic improvement but also a functional solution.

What Are the Risks and Benefits of Surgical Treatment for Brow Ptosis?

Surgical treatments for brow ptosis provide both aesthetic and functional improvements, but they may also come with certain risks. The treatment generally aims to reposition the eyebrows to a more youthful position, thereby addressing both visual and functional issues.

Benefits:

• Expansion of the visual field
• A younger and more energetic appearance
• Reduction in forehead muscle-related headaches

Risks:

• Wound and scar formation during the healing process
• Risk of asymmetry between the eyebrows
• Possibility of infection
• Numbness due to nerve damage
• Temporary or permanent hair loss
• Hematoma (accumulation of blood)
• Changes in skin sensation
• Unexpected aesthetic outcomes

The surgical technique used during the brow lift procedure can influence both the level of benefits and the level of risks. For example, endoscopic methods tend to leave less scarring, while traditional techniques may result in more noticeable scars.

What Is the Recovery Process Like After Brow Ptosis Surgery?

The recovery process after brow ptosis surgery proceeds more comfortably and quickly when the patient follows the recommended care instructions. There are important points to be cautious about from the very first days, and the process is generally completed within a few months:

• Use of eye drops and ointment,
• Regular application of cold compresses during the initial days,
• Keeping the head elevated,
• Avoiding physical activities,
• Maintaining hygiene of the surgical area,
• Taking the medications prescribed by the doctor regularly.

During the first week after surgery, mild pain, swelling, and bruising may occur. These symptoms usually decrease and disappear over time. Stitches are typically removed within 7-10 days, and the patient can resume light daily activities. However, it is important to avoid heavy work and intense physical activities.

In the 2nd or 3rd week of the recovery period, swelling significantly diminishes. As the patient’s overall condition improves, physical activities can gradually be increased. Strenuous sports should not be started without the doctor’s approval.

At the end of three months, the final results of the surgery become visible as the swelling around the eyes completely subsides. During this period, it is important for the patient to pay attention to their general health. Post-surgery results provide a natural and youthful appearance that suits the individual’s facial structure. Regular follow-up appointments in the post-surgery period are critically important for monitoring the healing process and ensuring patient satisfaction.

References

1. Matarasso, A., & Matarasso, S. L. (2001). Browlifting: Current techniques. Plastic and Reconstructive Surgery, 108(6), 1409-1424.
2. Knize, D. M. (2009). An anatomically based study of the mechanism of eyebrow ptosis. Plastic and Reconstructive Surgery, 123(5), 1320-1327.
3. Carruthers, A., & Carruthers, J. (2007). Eyebrow shape and perceived age: Quantitative analysis. Dermatologic Surgery, 33(1), 126-131.
4. Lambros, V. S. (1997). Observations on periorbital and midface aging. Plastic and Reconstructive Surgery, 99(6), 1360-1366.

Dr. Erman Ak

Op. Dr. Erman Ak graduated from Ankara Hacettepe Tıp in 2014 and completed his specialization at Istanbul University Çapa Medical Faculty. He received advanced microsurgery training in Taiwan and, as an ISAPS fellow in Italy, training in facial and breast aesthetics. Dr. Ak holds the European Union Aesthetic Plastic Surgery qualification certificate from EBOPRAS and contributed to the establishment of the Plastic Surgery Department at Başakşehir Çam and Sakura Hospital. He currently accepts patients from Turkey and various other countries at his clinic in Nişantaşı.