Like the upper and lower lid, structures that maintain eyebrow position often weaken with age.
The muscle that lifts eyebrow only has loose attachment to the lateral part of the brow. This is often the first area to atrophy leading to the lateral brow being the earliest part to droop. This can create a hooding of the lateral eyelid and exacerbate any excess skin of the upper lid.
Often, only the position of the temporal part of the brow needs to be addressed, however in some cases the whole brow may need elevating.
There are numerous methods of altering the eyebrow position each with their own indications and shortfalls.
Direct Brow Lift - The most effective method is the direct brow lift with or without periosteal fixation. This leaves a scar above the brow which is often inconspicuous. A wound may be placed just anterior to the hairline in a pretrichial or endoscopic lift. A pretrichial is not as powerful as a direct but the wound is well hidden. An endoscopic lift requires special equipment at an added expense.
Botox - Botox may allow a small amount of lift lasting several months but would need ongoing administration for longer term effect.
Internal Browpexy - An internal browpexy may be performed at the time of upper eyelid surgery through an upper lid crease wound. This technique prevents descent of the brow in time and may achieve a small amount of lift.
Your surgeon can discuss all options and help decide if any method would be suitable.