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7 Methods for Non-Surgical Eyebrow Rejuvenation—Part 2

In our most recent article (link here), we discussed the 3 non-surgical eyebrow rejuvenation techniques—Botulinum Toxin, Dermal Fillers, Fractional Radiofrequency and Radiofrequency fractional Microneedling. In this article, we will cover the 4 more non-surgical eyebrow rejuvenation techniques which are High-Intensity Focused Ultrasound (HIFU), Thermo-Mechanical Ablation, Lasers, and Thread Lifting.

The brow region is one of the major aesthetic features visible on the face and plays a significant role in facial and mood expressions. The brow is a complex and dynamic structure influenced by an individual’s gender and age. The male brow is broader and heavier than the female brow and lies over the superior orbital rim with little arch on a horizontal plane, whereas the female brow begins medially at or below the rim and ascends laterally with an arch, peaking in the lateral third as it tapers laterally.

Aging causes a decrease in bone, fat, collagen, and muscle volume in the supraorbital compartment, giving the face a sunken aspect. Furthermore, textural inconsistencies and a loss in tissue quality and elasticity reduce the superior orbital rim’s scaffolding ability, resulting in downward sagging of the brow, which not only gives an individual a fatigued, sad, or sunken appearance but may also impede vision. The lateral brow segment is more vulnerable because it receives less support from deeper structures than the medial brow. Although both men’s and women’s brows can descend with age, men’s brows are usually more resistant to such descent until they are 50 or older. However, current research indicates that the influence of aging on brow position is a complex process.

Moreover, temporary eyebrow shaping has become more frequent and is under higher demand among the younger population due to fast-evolving and changing beauty standards. The ideal aesthetic look of the brows varies by gender, with women preferring higher and more arched brows than men. Patients frequently contemplate brow lifting to correct extra skin; however, this procedure requires a major and sometimes expensive surgical procedure, with significant downtime and possible consequences such as deformity or scarring. As a result, non-surgical and minimally invasive rejuvenation procedures have grown in popularity over the last decade, with benefits such as reduced downtime, a higher cosmetic return, and a lower risk of side effects. This article provides a brief overview of recent publications on non-surgical brow lifting and reshaping procedures, and our feedback and practical experience on best practices in this field.

Ethnicity and Gender Beauty is a cultural concept. Historically, beauty standards have had a strong connection with cultural and ethnic backgrounds. Globalization has diminished the cultural differences between different nations and ethnic groups in the last two decades, including beauty standards. However, there are still distinctive facial and anatomical features. For example, the Chinese actress Fan Bingbing is considered the epitome of female beauty. She has childlike facial features; a round face; thin, rather straight eyebrows; comparatively large eyes with a lower eyelid roll; an oval face with a round and narrow chin; and sexually dimorphic traits, such as full, prominent lips. In contrast, the Western ideal of feminine beauty, Angelina Jolie, has prominent cheeks and jawline, submalar hollowing, and full lips.

Below shows the images of Fan Bingbing (left) and Angelina Jolie (right).

Asians, including those with Fitzpatrick skin phototypes III and above, show fewer age-related rhytids than Caucasians. This has been attributed to a thicker dermis, increased fat above and deep within the superficial muscular aponeurotic system, and dense fat and fibrous connections between the superficial muscular aponeurotic system and deep partoid masseteric fascia, based on anecdotal evidence from cadaver dissections.

Some muscles, such as the corrugator supercilii, have a lesser mass in Asians than Caucasians; the corrugator supercilii are also often shorter, thinner, and less hyperdynamic. Variations in the frequency of certain facial expressions, such as frowning, are believed to provide a genetic and cultural foundation for these distinctions. In contrast, Asians have masseter muscles that are typically more developed than most Caucasians.

In an interesting study, photographs were taken of the faces of two Asian women and two Caucasian women of varying ages. The images of each model were altered to generate different eyebrow shapes. Subsequently, the author recruited and gathered demographic information from volunteers from the general public to evaluate the altered photographs according to their aesthetic preferences. The authors found that neither the ethnicity of the models nor the ethnicity of the volunteers who judged them significantly influenced the optimal location of the eyebrow arch. However, a more medial brow apex is generally preferred in older faces, whereas a more lateral brow apex is preferred in younger faces.

Nevertheless, Asian brows feature a slightly straighter bow than Caucasians’ angular arch, and their brow lines are gentler. Asian faces with highly arched brows might appear particularly artificial, dui in part to their relatively wider width. The optimal brow shape for Asian women is flatter and lower in the lateral two thirds than Caucasians, historically. Asians avoid the lateral arching of the brow, often known as the "Samurai eyebrow", which is regarded as a less desirable "angry look". Other cultures might have different beauty standards, including, but not limited to, eyebrow shape and elevation. Gender has always played an important role in beauty standards and natural eyebrows. Caucasian females of all age groups have much higher eyebrows than their male counterparts. In a study with younger and middle-aged cohorts, African American females had a considerably higher eyebrow height than males. In nearly all Caucasian and Afro-American males, the distance between the brow apex and the lateral corneal limbus was higher than in females. In contrast, women had a larger brow apex angle than men.

Forehead Anatomy

Below shows an eight-layer configuration that has been identified in the forehead, as shown in Figure 3. These layers, from superficial to deep, are as follows:

The eight-layer forehead configuration system. The fascial layers are exposive fashion, beginning at the skin (medially) and progressing deeper till they reacally, temporal crest). The hue of the neighboring fat can also be used to determine structure. The superficial fatty layer is the lightest (yellow), the retrofrontalis fat (bright orange), and the preperiosteal fat is the darkest (dark orange). Note how the orbicularis retaining ligament and the supraorbital ligamentous adhesion transition into more superficial layers and provide boundaries for cranial and caudal compartments.

  • Layer 1: skin;

  • Layer 2: superficial fatty layer;

  • Layer 3: suprafrontalis fascia;

  • Layer 4: orbicularis oculi and frontalis muscle (same plane);

  • Layer 5: a homogenous layer of fat (preseptal fat (in the upper eyelid), retro-orbicularis oculi fat (deep to the orbicularis oculi muscle), and retrofrontalis fat (deep in the occipitofrontalis muscle));

  • Layer 6: subfrontalis fascia;

  • Layer 7: preperiosteal fat within the prefrontal space in the lower forehead and deep compartments in the upper forehead;

  • Layer 8: periosteum bone.

Non-Surgical Eyebrow Lift Treatments

1. Botulinum Toxin

2. Dermal Fillers

3. Fractional Radiofrequency and Radiofrequencyfractional Microneedling

4. High-Intensity Focused Ultrasound (HIFU)

The Food and Drug Administration (FDA) approved the high-intensity focused ultrasound (HIFU) brow-lifting technique in 2009. Acoustic energy creates heat in the range of 60 to 70 Celcius, taedrgUetlitnrgastohuende(eHpIdFeUr)mis and superficial musculoaponeurotic system (SMAS), causing collagen denouement, new collagen synthesis, skin tightness, and elevation. The thicknesses of the facial skin layers vary somewhat anatomically; hence, the depths of the targeted therapy layers must be modified correspondingly. Multiple studies have shown significant improvements in facial ptosis, specifically of the brows, nasolabial folds, mandibular angle, and platysma, after HIFU treatment. Histologic examination revealed increased collagen regeneration following treatment. One study reported an elevation of the eyebrow by 1.7mm after 90 days of treatment.

Moreover, a multimodel approach combines botulinum toxin, fillers, and microfocused ultrasound to rejuvenate the periocular region. First, the supra-brow, lateral canthus, and infraorbital areas were treated with micro-focused ultrasound MFU. The filler was injected into the sunken upper eyelid, lateral brow, and infraorbital region. Finally, on the same day, botulinum toxin was injected into the forehead, glabella, crow’s feet, and lateral orbital margin behind the brow. In a pilot study, a hybrid device that combined HIFU and fractional RF technology was effective in facial and neck rejuvenation, including eyebrow lifting. The efficacy of the hybrid device was not compared with the efficacy of standalone HIFU or fractional RF devices.

5. Thermo-Mechanical Ablation

Thermo-mechanical ablation technology has been used for medical and, more re- cently, cosmetic purposes. The FDA cleared the technology in 2021, and it is intended for dermatological procedures that require skin ablation and resurfacing. For correcting peri-orbital wrinkles, the efficacy of this technology was comparable to that of fractional laser. The most successful application of this technology is to increase skin permeability and enhance the local delivery of topical medication, as discussed in the microbotox.

6. Lasers

Laser therapy is one of the most popular options for skin rejuvenation. It can target various concerns, including wrinkles, fine lines, age spots and more—including laser therapy through ablation, coagulation, or a combination of them. Histochemical research revealed that the eyelids have greater levels of collagen 30 days after a single CO2 treatment. However, ablative (such as CO2 and Er:YAG) and non-ablative fiberglass fractional lasers are primarily used for upper eyelid dermatochalasis and periorbital rejuve- nation rather than brow elevation. A recent case report discussed an eyebrow lift using Er:YAG in smooth mode, which relies merely on the coagulation effect of the laser.

7. Thread Lifting

Eyebrow thread lifting is a minimally invasive technique that may correct mild-to- moderate ptosis while providing good cosmetic outcomes. In the absence of ptosis, thread lifting is an excellent option for repositioning the brow and improving the gaze. Threads provide actual mechanical suspension, which is a significant advantage over previous methods of eyebrow elevation. The first report on using threads in a cosmetic suture suspension procedure was in 1993. Since then, threads have significantly improved in material, shape, and procedure.

Threads are characterized by their composition, shape, thickness, and implementation methods. Currently, most of the commonly used threads are either absorbable (polylactic acid, caprolactone threads, polydioxanone) or semi-absorbable (polypropylene-polylactic acid) threads.

In terms of shape, threads are classified into mono, spring, twin, uni-direction cogged, bi-direction cogged, and multi-direction cogged threads. Each of these threads has a unique indication and implementation process. Cogged (barbed) threads are primarily used in the brow lift procedure. Moreover, barbs can be substituted with cones in bi-directional threads, such as Silhouette Soft.

Threads are loaded on a sharp needle, into a cannula, or attached to a single or double needle, which determines the implementation procedure. The UPS system commonly denotes the size to number their thickness relative to their diameter. The numbering system revolves around the “0” suture, and the number preceding the “-0” denotes the number of zeros in the UPS size. The strand’s diameter decreases as the number of zeros in the suture size increases. Suture size thus increases from USP 0 to 1.2 and upwards, while it decreases from 0 to 2-0 (00), 3-0 (000), and downwards. Moreover, the manufacturing of cogged threads has recently improved from laser cutting to pressing and molding, enhancing the thread resistance.

One of the most common techniques uses cogged threads loaded into the cannula to raise the eyebrows by inserting two to four cogged threads at the insertion point (A), 1 cm below the hairline, for a medial and lateral brow lift, as shown in the figure below. To avoid trauma to the temporal branch of the facial nerve, one should insert the first cog thread through the sub-dermis and end at point B, 1 cm above the brow. After anchoring the cog thread, one can then slowly retract the cannula and clamp the cog thread. Then, one should sub-dermally insert the second cog thread towards end-point C, 1cm above the brow and parallel to the lateral canthus line, and then clamp together both cog threads and trim them close to the skin.

Below shows the use of unidirectional cogged threads for eyebrow central elevation (left) and lateral elevation (right). (A) de-note the entry point (B-D) denote the anchoring points.

The two most common techniques for eyebrow elevation when using bi-directional threads attached to two needles are the L-shape and U-shape techniques, as shown in the figure below. The U shape provides more lifting along the medial line, while the L shape enhances the lateral elevation. Other less common insertion models are the N-shape and O-shape techniques.

Below shows the use two-needle thread in L Shape (left) and U shape (right). For the L shape, (A) denote the entry point, (B) the anchoring point and (C) the exit point. For the U shape, (A,B) denote the entry and exit point respectively. (C,D) denote the anchoring points.

Experts' Opinions

BTX injections are the most popular and least expensive non-surgical brow lifting technique. The procedure is relatively simple, and there is plenty of educational material to support its use. However, new practitioners should avoid injecting BTX to elevate and reshape the brow until they have mastered the necessary hand skills and injection techniques. Most patients have considered the procedure affordable and effective in the last three months. Dermal fillers can significantly improve the outcomes of BTX injections. Injecting fillers in the brow and periorbital area, on the other hand, requires advanced training to avoid occulusion. We strongly advise using a blunt cannula rather than a sharp hypodermic needle. Practitioners should satisfy a 10-point planning system to improve the safety of filler injection procedures.

The 10 points include the following:

  1. Patient history and selection

  2. Patient Assessment

  3. Patient informed consent

  4. Filler reversibility

  5. Product Characteristics

  6. Product Layering

  7. Before and After photography

  8. Procedural planning and aseptic technique

  9. Injection Anatomy

  10. Technical Knowledge

The use of threads for brow lifting has grown in popularity in recent years. While the procedure is more invasive than the injection of BTX and fillers, the results are more impressive and last longer. It is simpler to use barbed threads loaded on a cannula than bi-directional threads equipped with two needles.

Except for HIFU technology, there is a lack of strong evidence in favor of using energy- based machines for brow lifting. Although some studies found statistically significant differences in eyebrow elevation, patient satisfaction remained low. Patients are required to receive multiple treatments, which can be costly and time-consuming. Furthermore, these methods are costly and necessitate practitioners’ purchase of expensive machines.


Expert Opinion on Non-Surgical Eyebrow Lifting and Shaping Procedures (2022) by Dima Omran, Salem Tomi, Adel Abdulhafid and Kamal Alhallak

The fat compartments of the face: anatomy and clinical implications for cosmetic surgery (2007)

Anatomy of the SMAS revisited (2003)

Surgical anatomy of the mimic muscle system and the facial nerve: importance for reconstructive and aesthetic surgery (2000)


Uncovering the benefits, indications, & limitations of thread lifting in our upcoming Advanced Asian Non-Surgical Face Lifting Master Class happening globally:

IFAAS Master Class (Hands-On)

Korean Advanced Non-Surgical Face Lifting

Using Aesthetic Injectables, Devices and Thread Lifting

July 2, 2023 - London, United Kingdom - [Register Now]

IFAAS Master Class (Hands-On)

Korean Advanced Non-Surgical Face Lifting

Using Aesthetic Injectables, Devices and Thread Lifting

July 15-16, 2023 - Sydney, Australia - [Register Now]

IFAAS Master Class (Hands-On)

Korean Advanced Non-Surgical Face Lifting

Using Aesthetic Injectables, Devices and Thread Lifting

Sept 9-10, 2023 - Vancouver, Canada - [Register Now]


More Upcoming Aesthetic Trainings Happening Globally


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