Non-Surgical Eyebrow Rejuvenation Techniques: A Review

September 2021 | Volume 20 | Issue 9 | Original Article | 970 | Copyright © September 2021


Published online August 31, 2021

Wasim Nasir MDa, Shino Bay Aguilera DOb, Eduardo Weiss MDc

aPGY4 Dermatology Residency Training Program, Larkin Community Hospital, South Miami, FL
bShino Bay Cosmetic Dermatology & Laser Institute in Fort Lauderdale, Fort Lauderdale, FL
cHollywood Dermatology and Cosmetic Surgery Specialists, Hollywood, FL

Abstract
Background: Eyebrow rejuvenation is a common cosmetic concern among patients presenting to dermatologists. Due to increased patient demand for non-invasive procedures, multiple non-surgical, and minimally invasive eyebrow rejuvenation techniques have been developed.
Objective: This review aims to highlight the various non-surgical eyebrow rejuvenation therapeutic techniques described in the medical literature.
Methods & Materials: A review of published articles on non-surgical and minimally invasive eyebrow rejuvenation using neurotoxins, fillers, lasers, threads, bimatoprost solution, and tattooing was conducted using the PubMed database.
Results: Currently available non-surgical options for eyebrow rejuvenation include neuromodulators, fillers, laser resurfacing, radiofrequency, and minimally invasive procedures such as tattooing and brow lift using threading.
Conclusion: The eyebrow is a complex and dynamic region. A thorough understanding of the anatomy of the supraorbital region and familiarity with available, minimally invasive treatment options is essential to tailor an individualized approach consisting of one or more treatments to achieve optimal rejuvenation outcomes.

J Drugs Dermatol. 2021;20(9):970-978. doi:10.36849/JDD.6188

INTRODUCTION

The eyebrow region is among the first cosmetic structures visible on the face and is important for facial expression and emotion. Structurally, the eyebrow represents a complex and dynamic area influenced by both the gender and age of an individual.1 The male brow is typically thicker and heavier than the female brow and lies over the superior orbital rim with little arch on a horizontal level, while the female brow starts medially at or below the rim ascending laterally with an arch, peaking in its lateral third as it tapers laterally.2,3

Aging leads to depletion in the volume of bone, fat, collagen, and muscle in the supraorbital compartment, which may result in a hollowed appearance. Additionally, texture irregularities and decrease in tissue quality and elasticity weakens the scaffolding ability of the superior orbital rim, leading to downward sagging of the brow that not only gives an individual a tired, sad, or sunken look, but may also impair vision.4-7 The lateral eyebrow segment is particularly affected as it has less support from the deeper structures than the medial brow.8 Although brows of both women and men may descend with increasing age, the brows in men are usually more resistant to such descent until they reach age 50 or older. However, current evidence shows that the effect of aging on eyebrow position is a complicated process.7, 9-11

Brow ptosis is among the first visible signs of aging. It changes the shape and contour of the aging face, and thus represents a common concern for patients presenting to cosmetic dermatologists seeking eyebrow rejuvenation. Moreover, the desired aesthetic appearance of the eyebrows is gender-dependent, with women generally desiring higher and more arched eyebrows compared to men.12 Often patients consider correction of excess skin by brow lifting; however, this process involves a major, and often times expensive, invasive surgical operation with risk for considerable downtime and complications such as disfigurement or scarring. Consequently, non-invasive and minimally invasive rejuvenation procedures have become increasingly popular within the last decade with advantages, such as limited downtime, relatively larger aesthetic return, and low risk for complications. Here, we review the various non-surgical and minimally invasive techniques available to patients seeking eyebrow rejuvenation.13

Anatomy of the Supraorbital Area
A thorough understanding of the eyebrow muscle anatomy and functions are needed for consistent and favorable eyebrow rejuvenation outcomes (illustrated in detail in Figures 1 and 2). The frontalis muscles serve as the brow elevators, which give rise to horizontal forehead wrinkles. The superolateral portion of the orbicularis oculi is a lateral brow depressor. The procerus, corrugator supercilii, and depressor supercilii oculi work in concert to depress the medial brow. The corrugator causes vertical glabellar rhytids, while the procerus causes horizontal