The eyes are the windows to the soul – so what can be done when age and gravity catch up and your eyes lose their sparkle?

- This Quarterly October 2016 -

Brow ptosis is a term used to describe a condition in which skin and muscles of the forehead around the eyebrows become lax, resulting in a droopy appearance. When that happens, the eyes will start to look lifeless and tired. Since the eyes are commonly the focus of a person’s face, brow ptosis will have a negative effect on one’s overall looks and even affects interactions with others.

The most common cause of brow ptosis is, of course, ageing. The muscle holding up the forehead eventually loses the battle against gravity and time, causing the skin to become lax. With ageing also comes loss of bone volume, which causes the brow bones to recede, giving the brows a sunken appearance and worsening the droop. This process begins in women above 40, while for men it usually starts a bit later at 50.

Rarely, brow ptosis may be a result of nerve palsy or secondary to trauma.


Treatments for brow ptosis can be classified into two groups: non-invasive and invasive.

  • Non-invasive

    In simple medical terms, noninvasive procedures refer to treatments that do not require cutting the skin. Since there is little or no downtime involved, it is generally possible to undergo a non-invasive treatment and head back into normal everyday activities right away.Non-invasive treatments are recommended for milder cases of brow ptosis. They include Ulthera or Thermage, which use ultrasound or radiofrequency waves respectively to stimulate collagen renewal, providing a light lift of about 2mm. Hyaluronic acid fillers are also especially useful in patients who show signs of volume loss. A few jabs of Botox give nice immediate effects in mild droopiness. Korean Polydiaxonone (PDO) threads are currently in vogue.These resorbable threads act by stimulating collagen formation. Threading is not considered a long-term solution as effects last about 1.5 years on average.

  • Invasive

    On the other end of the treatment spectrum, invasive procedures involving Ulthera or eye surgery require more time to recover from swelling and occasional bruising. Invasive procedures are usually required for the adequate treatment of moderate to severe brow ptosis. Effects usually last seven to 10 years.The temporal browlift, which requires a hidden incision made within the temporal hairline, provides localised lateral lift to address skin hooding of the corners of the eyes. For a more complete forehead lift, the endoscopic browlift involves five hidden short incisions made within the hairline to lift the entire forehead’s skin and muscle. This procedure can completely overhaul droopy eyes.The Endotine TransBleph procedure makes use of patented resorbable implants for dramatic upper face rejuvenation. The procedure takes about 1.5 hours, can be performed under local anaesthesia and involves making small hidden incisions identical to those used in upper eyelid surgery.The technique approaches the brow from the bottom, effectively shortening the forehead and creating a more lifted, brighter, youthful look as a result. This procedure gives similar durable results as an endoscopic lift and is more suitable for those with high foreheads or receding hairlines.