Brow lift options: Botox vs thread lift vs Ultherapy vs surgery

Brow ptosis (drooping brows) is one of the most impactful changes in facial aging — low brows make the eyes look heavy, the face look tired, and can contribute to upper lid hooding. The options range from a $200 Botox touch to a $10,000+ surgical procedure. Here's how to choose.

Why brows drop

The brow is maintained by a balance between:
Elevating forces: Frontalis muscle (forehead)
Depressing forces: Orbicularis oculi, corrugators, depressor supercilii

With aging:
Soft tissue descends due to gravity and volume loss
The forehead skin elongates
Fat pads atrophy, reducing tissue support
Bone remodeling changes the orbital rim shape

The result: brows that were once at or above the orbital rim (the ideal position) gradually descend toward or below it.

Male vs. female brow position: Men naturally have lower-set, straighter brows close to the orbital rim. Women naturally have higher brows with an arch peaking at the lateral third. Any brow lift approach must respect these aesthetic norms — feminizing a male brow or masculinizing a female brow creates an unnatural result.

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Option 1: Botox brow lift

Mechanism: By weakening the brow depressors (lateral orbicularis oculi, corrugators) while leaving the frontalis (elevator) intact, the frontalis "wins" the tug-of-war and the brow rises slightly.

What it achieves:
1–3 mm of brow elevation
Subtle arching of the lateral brow tail (the most aesthetically impactful part of the brow for women)
Visible improvement in the heaviness around the eye

Dose:
Lateral orbicularis oculi: 2–4 units per side
Glabella (corrugators): 20–30 units (the standard glabellar treatment already contributes to medial brow lift)
Total "brow lift" specific add-on: 4–8 units on top of standard glabellar treatment

Cost: The incremental cost for a Botox brow lift over standard glabellar treatment is typically $50–$200 (a few additional units). Many providers include it in a full-face protocol without a separate charge.

Duration: 3–4 months.

Best for: Mild brow ptosis; patients who want subtle lift without commitment; patients already doing Botox who want to optimize results.

Limitation: 1–3 mm is the realistic ceiling. Patients with moderate-to-severe ptosis will not see adequate improvement.

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Option 2: PDO Thread brow lift

Mechanism: Fine PDO threads are inserted under the brow skin using a needle or cannula, then anchored to provide mechanical lift. See our PDO thread lift guide for full detail.

What it achieves:
2–5 mm of brow elevation immediately
Visible lateral brow arch improvement
Collagen stimulation for some sustained improvement after threads dissolve

Duration: 12–18 months.

Downtime: 3–7 days of swelling and bruising; possible dimpling at insertion sites for 1–2 weeks.

Cost: $600–$1,200 for the brow area.

Best for: Patients with mild-to-moderate brow ptosis who want more lift than Botox but aren't ready for surgery; good bridge treatment.

Limitation: Results are modest compared to surgery; threads can be visible or palpable; migration risk.

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Option 3: Ultherapy brow lift

Mechanism: HIFU (High-Intensity Focused Ultrasound) energy delivered at specific depths causes collagen contraction and new collagen production. FDA-cleared for brow lift specifically.

What it achieves:
1–3 mm of brow elevation
Results develop gradually over 3–6 months as collagen remodels
No immediate visible result

Duration: 12–24 months.

Downtime: Minimal — some temporary tenderness, tingling, numbness. No visible recovery.

Cost: $700–$2,000 for a brow-focused Ultherapy treatment.

Best for: Patients who want a non-invasive option with no downtime and are willing to wait 3–6 months for results; appropriate for patients with mild ptosis and good skin elasticity.

Limitation: Results are gradual and modest; patients with significant ptosis will be disappointed; not appropriate for those who want immediate visible change.

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Option 4: Surgical brow lift

Types:

Endoscopic brow lift: The most common surgical approach. 3–5 small incisions behind the hairline; an endoscope is used to release the brow depressors and elevate the forehead tissue. Sutured or fixated in the elevated position.

Temporal brow lift: Smaller incisions at the temples specifically; lifts the lateral brow. Less comprehensive than endoscopic.

Coronal brow lift: Incision across the top of the head from ear to ear. Provides maximal lift but is less common now due to extended scar and scalp changes.

Direct brow lift: Incision directly above the brow — used in specific cases, often older men where a scar can be concealed in brow hairs.

What surgery achieves:
5–15+ mm of brow elevation
Structural correction that addresses the depressor muscles directly
Long-lasting results (7–10+ years)

Recovery: 2–4 weeks; bruising and swelling; numbness at incision sites common and typically temporary.

Cost: $4,000–$10,000 depending on technique, surgeon, and geography.

Best for: Moderate-to-severe brow ptosis; patients who want durable, significant results; patients who have exhausted or outgrown non-surgical options.

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Head-to-head comparison

| Factor | Botox lift | Thread lift | Ultherapy | Surgical |
|---|---|---|---|---|
| Elevation achievable | 1–3 mm | 2–5 mm | 1–3 mm | 5–15+ mm |
| Duration | 3–4 months | 12–18 months | 12–24 months | 7–10+ years |
| Downtime | None | 5–7 days | Minimal | 2–4 weeks |
| Immediate result | Yes (2 weeks) | Yes | No (3–6 months) | Yes |
| Anesthesia | None | Local | None | Local or general |
| Cost | $50–$200 add-on | $600–$1,200 | $700–$2,000 | $4,000–$10,000 |
| Best severity | Mild | Mild-moderate | Mild | Moderate-severe |

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Decision framework

Mild ptosis + no downtime → Botox brow lift (optimize current Botox protocol)

Mild-moderate ptosis + willing to try non-surgical → Ultherapy or PDO thread (Ultherapy for gradual no-downtime; thread for more immediate but short-lived result)

Moderate-severe ptosis + surgery not appealing yet → Thread lift (most lift from a non-surgical option; understand it's a bridge, not a permanent solution)

Moderate-severe ptosis + want durable results → Surgical consultation (surgery provides correction that non-surgical cannot match at this level)

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Questions to ask your provider

Based on my brow position and facial anatomy, how much lift do I realistically need to achieve the result I'm imagining?
Can non-surgical options achieve that, or should I be consulting a surgeon?
For Botox: how are you specifically planning to modify the orbicularis to lift my lateral brow?
For Ultherapy: are you using the 4.5 mm transducer (SMAS depth) for the brow area, and how many lines?
For surgery: what technique do you recommend for my hairline, hair density, and brow pattern?

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