Brow lifts vs Botox: Do you need one or both?

Many people view plastic surgery procedures as having to choose one or the other. It's an either/or situation. However, as history has shown us, sometimes duos pack more punch. Like peanut butter and jelly or Batman and Robin, duos complement each other and give a better overall result.

This brings us to the question at hand... brow lifts versus Botox. Do you need one or both?

Brow lifts and Botox: What's what?

First, how do these procedures improve the look of the brow and forehead area?

Let's start with Botox.

"A Botox brow lift is a nonsurgical technique that can subtly elevate the position of the eyebrows by selectively relaxing the depressor muscles – those that pull the brows downward – while allowing the elevator muscles to function unopposed," said Lara Devgan, MD. "The result is a gentle lifting effect that opens the eye area, smooths frown lines and refreshes the upper face without surgery or downtime. While it can't reposition tissue structurally, it's highly effective for early signs of aging, minor asymmetries, or patients looking for a refined, preventative approach."

Yes, you read that right. It is possible to get some of the effects of a brow lift by targeting specific muscles with Botox.

"It fixes the wrinkles and shapes the brows elegantly and provides a small lift in younger patients," said Sara Dickie, MD. "Botox has solved a ton of problems in the upper face that brow lift surgery didn't or couldn't or doesn't always, so now you have even less people asking for brow lifts and less surgical opportunities to find the best technique."

Defining a brow lift is relatively easy.

"Surgical brow lifting allows for true repositioning of the brow and forehead tissues," said Dr. Devgan. "It addresses the deeper anatomical changes that occur with aging, such as drooping soft tissue, loss of elasticity and volume descent. A well-performed brow lift restores a natural, harmonious brow position, softens deep forehead furrows and can even improve visual field obstruction."

However, the definition of a brow lift doesn't cover the intricacies and nuances of facial surgical procedures and what they can realistically achieve.

"Brow lifts are one of the most variable procedures offered by plastic surgeons who focus on the face," said Dr. Dickie, noting that there are dozens of different techniques and no one "leading" technique that surgeons turn to for achieving a natural and harmonious aesthetic.

Why is that?

"I think that is because brow lifting is not as common as other facial procedures, so most surgeons do not have the benefit of trying multiple types of procedures and honing their technique as quickly as, say, blephs or facelifts, which have much more straightforward techniques that are taught and practiced through residency, fellowship and early career," said Dr. Dickie.

She also indicated that there are numerous types of brow lift techniques, as brow lifts can address different aesthetic issues. A surgeon may use a different technique if they are trying to eliminate forehead wrinkles versus if they are aiming to shorten the forehead or advance the frontal hairline.

Brow lift? Botox? Both?

So, do you need a brow lift or Botox? Maybe even both? It depends on the issues you want to improve.

"I generally recommend a Botox brow lift for younger patients or those with mild descent looking to refresh their appearance without surgical intervention," said Dr. Devgan. "It's also an excellent tool for maintaining results between surgical treatments. Surgery becomes the preferred option when there's significant tissue descent, deep static lines, or functional concerns. Age is less of a deciding factor than anatomy, expression dynamics and personal goals."

And what about a brow lift?

"For me, it is people who come in for a blepharoplasty, and 50 percent of the eyelid skin sitting on their upper lashes is because the eyebrow has fallen to at or below the orbital rim," said Dr. Dickie. "With my fingers, I can put the eyebrow in the position where it should be, and voilà! The eyelid skin is less folded and moves away from the lashes, the eyelid is less heavy and they almost don't need a bleph at all."

The problem is that "brow lift or Botox?" isn't the only question you must ask yourself. You may need to ask about the type of brow lift you require, as different techniques yield varying results, which can impact whether or not you'll need additional procedures.

"You can do what's called a browpexy, which is basically taking a suture and tacking the deep tissue of the eyebrow to the bone through the upper lid incision," said Dr. Dickie. "This is best done with a blepharoplasty, so you already have the skin removed for the upper lid, you go under the upper lid muscle to the orbital rim, two stitches and the brow is set."

This technique works for individuals who need a little support and lift of the brow, but Dr. Dickie warned the brow may start to fall after a few years.

One other surgical technique that can refine the look of the brow is the temporal brow lift.

"A temporal brow lift makes an incision along the temporal hairline or in the temporal scalp, tunnels under the skin to the outer brow and by removing skin, the surgeon shortens the distance between the lateral brow and the scalp and the outer brow gets lifted," said Dr. Dickie. "This is a nice procedure and lasts a long time, but it doesn't address anything about the wrinkles of the forehead or the middle part of the eyebrow."

So, are those your only options? Think again.

"Next is a gliding brow lift or a subcutaneous brow lift," said Dr. Dickie. "Extending the temporal incision along the frontal hairline and elevating the entire forehead skin. This allows you to lift the entire brow and releases the skin from the frontalis muscle, so it elevates the eyebrow and reduces wrinkles."

This technique can produce a longer scar that may show unless a person has bangs. While this surgical technique can skillfully position the brows, within about a year, the patient may need Botox to help address wrinkles.

Dr. Dickie also talked about the endoscopic brow lift, which uses three to five incisions in the scalp, going under the muscle of the forehead.

"True versions of this also cut the periosteum (lining of the bone) along the orbital rim to help mobilize the entire forehead soft tissue unit – periosteum, muscle, fat and skin," said Dr. Dickie.

It's important to note this approach does not markedly improve forehead wrinkles.

"They may not use the muscle as much and so forehead wrinkles are less, but they still usually need Botox," said Dr. Dickie. "The benefit is that the Botox won't drop their brows anymore because they had a lift."

Confused by all your options? Don't be.

"The honest truth is that most people who undergo browlifts still need Botox," said Dr. Dickie.

Combining both procedures can likely provide the best aesthetic results.

"For many patients, the best outcomes come from an integrative approach," said Dr. Devgan. "Surgery can restore structure and remove excess tissue, while Botox can fine-tune muscular movement postoperatively, helping to maintain symmetry and prevent the reformation of dynamic lines. Used together, they can extend the longevity of results and enhance the overall aesthetic harmony of the upper face."

The consensus is that you'll only know which procedure is correct for you by consulting a board-certified plastic surgeon. It is nearly impossible to determine which procedure will yield the best aesthetic result without an expert opinion and a professional's guidance in tailoring the procedures to your unique needs, as numerous variables are at play. 

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.