What is Brow Ptosis?

Brow ptosis, also known as eyebrow sagging, is a functional and aesthetic condition, characterised by the lower forehead and brow area falling downwards.

The eyebrows are a key facial feature which show expression and emotion. Changes in their position can significantly impact an individual's appearance and confidence:

• Affecting the overall balance and proportions of the face
• Reduced field of vision, affecting daily activities and independence
• Self-awareness about how others perceive them
• Loss of confidence in social and professional environments

Brow ptosis is a common concern that many people seek a solution for. The British Association of Aesthetic Plastic Surgeons (BAAPS) recorded a 20% increase in the number of Brow Lift procedures performed in the UK between 2023 and 2024.

Cadogan Clinic’s team of Consultant Facial Surgeons are experts in their field, providing the highest standards in patient care and outcomes. 

Our surgical centre of excellence, based in Chelsea, London, accommodates 35,000 appointments each year, with 100% of surgical patients saying they would recommend us to their family and friends.

Are Asymmetrical Eyebrows Normal?

Asymmetrical facial features are completely normal, and no one’s face is perfectly even. 

The eyebrows are especially prone to asymmetry because they are highly mobile, and the underlying muscles can exert different levels of strength or tension on each side.

Although a degree of asymmetry is normal, in some cases, the difference in asymmetrical eyebrows may be more severe, making it more noticeable. This can heighten self-consciousness and anxiety.

Even a small difference in the balance of the eyebrows can have an effect on an individual’s confidence. What affects one person may not affect another, and if you find that a sagging brow is affecting your quality of life, you shouldn’t let comparisons with other people’s concerns stop you from finding the best treatment.

What are the Symptoms of Brow Ptosis?

There are several functional and aesthetic symptoms associated with sagging or drooping eyebrows. These physical symptoms are also linked to a number of psychological symptoms, which may have a deeper impact on an individual's wider quality of life.

Physical Symptoms of Brow Ptosis

• Sagging skin above the upper eyelid, creating folds, and pushing down on the eye area
• Reduced distance between the upper eyelids and the eyebrow
• A heavy appearance to the brow bone area, making the eyes appear smaller
• Impaired field of vision, reducing eyesight and impacting daily activities
• Skin irritation around the upper eye and brow bone area caused by loose skin
• Changes in facial expression

Psychological Symptoms of Eyebrow Sagging

• Heightened self-consciousness about the appearance of the upper face
• Anxiety about how facial expressions appear and are perceived in social and professional environments
• Loss of confidence in eyesight, which may lead to avoidance of activities such as driving, resulting in loss of social interaction

The symptoms, severity and impact of brow drooping vary between individuals. Speaking with an experienced and qualified Consultant Facial Surgeon ensures a bespoke treatment plan, which precisely addresses your personal concerns.

What are the Causes of Brow Ptosis?

Brow ptosis causes can be natural or external, and typically affect the structure or function of the tissues in the brow bone area.

Ageing

As we age, the proteins collagen and elastin, which give the skin its strength and structure, naturally break down and are produced more slowly. This increases skin laxity, causing the skin to sag.

The skin around the eyes and the brow bone is especially thin and has less underlying fat to provide volume, causing signs of ageing show sooner than in other areas of the face.

In addition to natural ageing, external factors such as sun damage can accelerate the depletion of collagen and elastin.

Anatomy

Although most people have the same structure of muscles and tissue in the brow bone area, personal anatomical and physiological factors may affect their function.

Repeated facial movements and expressions alter muscle strength and tension. If this is unbalanced, one side may become stronger than the other, resulting in asymmetrical eyebrows.

Weight Loss

Dramatic weight loss can cause several changes to facial features.

As excess fat is lost, the skin may not retract into its previous position. Although there is limited fat under the brow skin, fat loss in other areas of the face can cause brow drooping as the overall placement of the facial skin changes.

Weight Loss Medication, such as Ozempic or Mounjaro, may exacerbate this concern, as the rapid nature of the weight loss doesn’t allow the skin to retract. This is known as Ozempic Face.

Eyebrow Hair Removal

There are various methods which people use to shape their eyebrows by removing excess hair.

Over time, these techniques can pull at the skin surrounding the eyebrows, causing it to weaken and stretch, leading to sagging.

Eyebrow shaping techniques which remove more hair in one go tend to be more aggressive and damaging to the skin. These may include methods such as waxing and threading. Because tweezing is more precise, it tends to be less damaging; however, over time, skin damage may still develop.

Medical Conditions

Several medical conditions can affect the position and balance of the eyebrows.

In some cases, the effects may be temporary and resolve on their own. However, some conditions may cause permanent eyebrow ptosis, which may require medical attention.

Medical conditions which can cause brow ptosis include:

• Stroke – During a stroke, a blood clot in the brain blocks the blood flow and nerve signals which control the facial muscles. This can cause one side of the brows and face to fall
• Bell’s Palsy – The most common cause of facial palsy, Bell’s Palsy is caused by inflammation of the facial nerve, resulting in one side of the face drooping due to facial paralysis
• Infection – Bacterial infections, including Meningitis or Lyme Disease, affecting the facial nerve, can cause the brows to drop on one side

Many patients will be aware of the cause of their eyebrow sagging before they speak to a surgeon about the best treatment. However, in cases where there is uncertainty, a qualified surgeon can provide a comprehensive assessment and diagnosis before discussing treatment options.

How to Fix Brow Ptosis?

There is a range of non-surgical and surgical treatment options available to address eyebrow sagging and asymmetrical eyebrows.

The best brow ptosis treatment will depend on your concerns and desired outcomes. During your consultation, your surgeon will discuss all available options, which are most suitable for you, and the results they can achieve.

Non-Surgical Brow Ptosis Treatment

Non-surgical brow ptosis treatments are an effective way to address sagging eyebrow skin.

However, they may not be appropriate for concerns arising from deeper muscle layers and may not provide long-term results.

Because of this, they are usually best suited to patients with mild to moderate skin laxity around the eyebrows, caused by ageing or other skin damage.

Anti-Ageing Injections

Anti-Ageing, or Anti-Wrinkle Injections, are a non-surgical treatment that smooths and tightens the skin by relaxing the underlying muscles.

A neurotoxin is injected into the muscles around the eyebrows, blocking overactive nerve signals that cause excessive movement in the brow bone area. This lifts the brows and enhances the arch for a flattering, balanced appearance.

Due to the sensitive and delicate nature of the eye area, it is essential to seek treatment from a qualified medical professional with specialist experience in this procedure.

Anti-Ageing Injections require follow-up appointments every 3-6 months to maintain the results.

Nitrogen Plasma Treatment

Nitrogen Plasma Treatment is a non-surgical skin rejuvenation procedure which tightens and smooths the skin.

The thermal energy of nitrogen plasma is applied to the skin to create a precisely controlled injury. This stimulates the skin’s healing response, producing collagen and elastin, and revealing a new layer of skin which is firmer, stronger and more toned, lifting the eyebrows.

The highly precise and controlled nature of Nitrogen Plasma Treatment delivers high-quality, long-lasting results that many patients find improve over time.

If you are considering Nitrogen Plasma Treatment for brow ptosis, it is essential to find an experienced and qualified medical practitioner who has experience in treating the eye area.

After the initial treatment, less intensive follow-up treatments are usually required every 18-24 months to maintain consistent results.

Morpheus8

Similar to Nitrogen Plasma Treatment, Morpheus8 is a non-surgical skin rejuvenation treatment, but it uses a combination of radiofrequency energy and microneedling.

Morpheus8 is able to target deeper skin layers to address more significant laxity and sagging. Radiofrequency and microneedling stimulate collagen and elastin production, helping remodel the skin.

To treat eyebrow ptosis, speaking with a qualified medical professional with experience in using Morpheus8 on the eye area is critical to achieve the best results.

In most cases, people require a course of 1-3 Morpheus8 treatments, depending on their concerns.

Brow Ptosis Surgery

Brow ptosis surgery is the best option to achieve long-term results and address deeper, functional concerns which are causing eyebrow sagging.

Surgical brow ptosis treatment is effective for severe brow drooping and concerns caused by muscular issues.

Brow Lift

A Brow Lift is a surgical procedure that lifts the eyebrows and tightens the surrounding skin.

A surgical Brow Lift procedure involves removing excess skin from the brow bone and surrounding area, before tightening the underlying tissue and repositioning the skin. This achieves a lifted, toned and balanced brow area, as well as improving the field of vision and opening the eyes.

Depending on the needs of the patient, there are several types of Brow Lift for ptosis surgery:

• Endoscopic Brow Lift – This technique involves an endoscope (a specialist, minute camera) being inserted into the skin. This allows the surgeon full visibility without making large incisions. This reduces scarring, but may not fully address more significant concerns.
• Coronal Brow Lift – To perform a Coronal Brow Lift, an incision is made running between the ears, behind the hairline, across the top of the head, to remove excess skin and lift the brow area. This comprehensive technique rejuvenates the entire upper face and conceals any scarring within the hair.
• Hairline Brow Lift – Small incisions are made at the top of the forehead, in front of the hairline, to allow excess skin to be removed, and the brows lifted. This prevents the hairline from being pulled back.
• Temporal Brow Lift – Also known as a Lateral Brow Lift, this technique addresses the outer brow. A small incision is made in each of the temples within the hairline, resulting in a lift to the outer eyes and brow.
• Direct Brow Lift – A Direct Brow Lift involves incisions and removing excess skin from directly above the eyebrows. This targets the position of the eyebrows, whilst leaving the rest of the forehead.

Reports from The Aesthetics Society show that the most Brow Lift patients are aged 51-64, and although 92.5% of patients are women, it is also among the top ten surgical procedures for men.

A Brow Lift can be performed as a standalone procedure, but is often combined with other facial surgeries, such as Facelift or Blepharoplasty, to enhance the final results.

Brow Lift surgery can be performed under local or general anaesthetic, or sedation, and usually takes 1-2 hours to complete.

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