A characteristic feature of the periorbital zone and eyebrows is the appearance of the first signs of aging. Therefore, minimally traumatic methods of rejuvenation of the upper third of the face are very popular among patients of aesthetic clinics.
Dr. Maryam Zamani talks about the features of aging of the eyebrow area, important points to take into account when choosing anti-age procedures, and also describes an integrated approach to their rejuvenation, including microfocused ultrasound, botulinum toxin and filler injections.
Aging of the eyebrow area: key features
Ptosis of the lateral brow is the result of permanent contraction of the orbicularis oculi muscle, loss of skin elasticity and insufficient support provided by dynamic balance:
• frontal muscle;
• eyebrow wrinkling muscle;
• circular muscle of the eye.
Studies have shown that as we age, the eyebrow actually rises, with the medial part of the eyebrow being higher than the lateral. Delyzer et al. showed that in patients younger than 50 years, the brow lift is reduced due to the drooping of the brow arch. There is then an increase in brow lift due to overactivity of the frontalis muscle and increased muscle tone at rest.
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Support of the medial part of the eyebrow or its slight drooping during aging is provided by the tone of the muscle that lowers the eyebrow. Atrophy of the supraorbital fat and lack of connection of the lateral part of the frontalis muscle with the most lateral part of the eyebrow leads to its ptosis.
Position, shape and symmetry of the eyebrows – important factors to consider when working with this zone.
Thus, when rejuvenating the brow area, it is necessary to focus on the lateral part of the eyebrow and its arch, while not affecting its medial part. It is also necessary to take into account volumetric changes in the area of the eyebrows: ptosis of the lateral part of the eyebrow can be a consequence of soft tissue atrophy, bone resorption, loss of skin elasticity, as well as the effects of gravity.
Excellent results can be obtained by correct repositioning of the brow and volumization of the temporal fossa.
Microfocused ultrasound for eyebrow rejuvenation
When the skin is exposed to microfocused ultrasound (MFU), zones of thermal microdamage (thermal coagulation points) are formed in the dermis and subdermal layer. During the procedure, the skin at a depth of 5 mm, i.e. its deep reticular and subcutaneous layer warms up to temperatures above 60°C. The papillary dermis and epidermis remain unaffected.
Under the action of MFU, collagen fibers in the superficial musculoaponeurotic system of the face and in the deep reticular layer of the dermis contract, and new collagen synthesis is triggered. The lifting effect is provided by the healing of thermal coagulation points with subsequent strengthening of the dermis and subdermal tissues.
The effectiveness of ultrasound procedures varies depending on the direction of the vector and the total amount of energy delivered. This procedure is painful, but pain can be controlled with pain medication.
Pain, swelling, headaches, numbness, partial paralysis, post-inflammatory hyperpigmentation, bruising and blisters – possible risks that should be discussed with the patient before the MFU procedure.
Fig. 1: before and after Tri Brow
Brow ptosis correction with botulinum toxin type A
Ageing eyebrows – a dynamic process in which muscle tone at rest and their balance play a significant role. Muscular balance can be restored by relaxing the muscles that lower the eyelids and eyebrows.
Studies have shown that in patients under 50 years of age, paralysis of the central frontal and lateral orbicularis oculi muscles can be effective in correcting lateral brow ptosis.
Botulinum toxin – an effective neuromodulator used to temporarily weaken the orbicularis oculi and drooping brow muscles with minimal risk of side effects.
How to avoid complications after botulinum toxin injections
In older patients, frontalis muscle activity may be necessary to maintain brow height, so care must be taken when working with this aspect.
The role of hyaluronic acid-based fillers in the rejuvenation of the eyebrow zone
When choosing a filler for eyebrow correction, it is necessary to pay attention to the viscosity of the gel and its elasticity. The author prefers to use fillers from the Juvéderm line, in particular Volift, for lifting the lateral part of the eyebrow and replenishing lost volumes, since this product has an excellent lifting ability and is well distributed in the tissues.
The Tri Brow Treatment, a non-surgical eyebrow correction protocol created by the author, includes injections of botulinum toxin, HA-based fillers and exposure to microfocused ultrasound.
When filling in the brow area, the shape of the lateral brow, as well as the vascular and structural anatomy, must be taken into account. In order to volumize, HA can be injected into the lateral part of the eyebrows and temples both deeply (above the periosteum and under the muscles) and dermally.
All periorbital HA injections carry significant risks (vascular damage, overcorrection) and should therefore be corrected with extreme caution.
Filler Correction: Rules for Safe Work in the Periorbital Area
Combination Approach: Tri Brow Treatment
The Tri Brow Treatment, a non-surgical eyebrow correction protocol created by the author, includes injections of botulinum toxin, HA-based fillers and exposure to microfocused ultrasound. The procedure is performed in two sessions with an interval of 10-14 days in order to eliminate eyebrow ptosis in patients aged 30-55 years.
As part of the first session, ultrasonic lifting of the periorbital zone Ultherapy is performed.
Approximately 10-14 days after Ultherapy, the lateral part of the eyebrow and temples are corrected with HA fillers, and botulinum toxin injections are performed in the muscle that lowers the eyebrow and the orbicular muscle of the eye.
The end result of correction with Ultherapy appears after 3-6 months. It is also worth noting that repeated injections of botulinum toxin (duration of action - from 3 to 5 months) and hyaluronic acid (duration of action depends on the type of drug used) are necessary to maintain the results.
Based on his experience, Dr. Zamani claims that the combined use of microfocused ultrasound, botulinum toxin type A and hyaluronic acid provides effective rejuvenation of the eyebrow area, is associated with minimal risks of side effects and is characterized by a high degree of patient satisfaction.
Adapted from Aesthetics
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