As the facial soft tissues descend, the position of the brows can lower (brow ptosis) and cause a “stern”, aesthetically unappealing facial expression. When the tails of the brow fall more than the central brow region, this can result in a “happy” or “surprised” look, which can also be socially distracting.
Additionally, brow descent can exacerbate eyelid drooping. In women, the brows are slightly above the superior orbital rim. In men, the brows are naturally lower and at the bony rim. We can restore the brow position using a pre-trichial approach (incision placed just in front of the hairline) that results in higher brows, a smoother forehead, and an incision that blends seamlessly into the hairline. For milder cases of brow ptosis, an external browpexy can be performed with less removal of tissue and suspension of the brow to the lining of the bony rim.