Management of the aging brow has classically involved surgical therapy. Energy-based devices causing skin tightening, neuromodulators, or brow dermal filler volume placement can create brow lifting.
Materials & Methods:
Retrospective, consecutive patient review of Artefill (ART), now Bellafill, injection along superior brow hair to provide permanent brow lifting. The degree of brow suspension was evaluated regarding the medial, peek, and lateral brow calibrated measurements, injection site filler placement, complications, and patient satisfaction.
Results:
From 2015 through 2022, 113 patients underwent ART (Bellafill) brow lifting alone or simultaneously with upper cosmetic eyelid surgery (blepharoplasty). Using the global aesthetic improvement scale (GAIS) assessment reached 88.5% patient satisfaction with very much improved or improved responses. Brow measurements showed 80.0% having brow elevation by mean of 2.13 mm with 92% required one syringe (half of syringe per side) and injecting with a 25 G microcannula in 96%. The only side effect or complication observed was bruising (5.3%).
Conclusions:
Bellafill (ART) brow lift is a safe and effective minimally invasive procedure that uses no anesthesia (except synthetic ice) with microcannula filler administration, which reduces side effects and complications. This technically simple procedure provides long-term brow lift results comparable with surgical therapy outcomes in selected patients.
RohrichRJPessaJERistowB. The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg. 2008;121(6):2107-2112.
5.
MendelsonBCHartleyWScottMMcNabAGranzowJW. Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthetic Plast Surg. 2007;31(5):419-423.
6.
KochRJTroellRJGoodeRL. Contemporary management of the aging brow and forehead. Laryngoscope. 1997;107(6):710-715.
7.
SavetskyILMatarassoA. Lateral temporal subcutaneous bow lift: clinical experience and systematic review of the literature. Plast Reconstr Surg Glob Open. 2020;8:e2764.
8.
WongkietkachornAWongkietkachornN. Endoscopic gliding forehead lift: a brow shaping method to lift the medial and lateral brow. Aesthetic Plast Surg. 2025;49(20):5712-5718.
9.
KarimiNKashkouliMBSianatiHKhademiB. Techniques of eyebrow lifting: a narrative review. J Ophthalmic Vis Res. 2020;15(2):218-235.
10.
FrankelASKamerFM. Chemical browlift. Arch Otolaryngol Head Neck Surg. 1998;124(3):321-323.
11.
AhnMSCattenMMaasCS. Temporal brow lift using botulinum toxin A. Plast Reconstr Surg. 2000;105:1129-1135.
12.
KashkouliMBAmaniAJamshidian-TehraniMYousefiSJazayeriAA. Eighteen-point abobotulinum toxin an upper face rejuvenation: an eye plastic perspective on 845 subjects. Ophthalmic Plast Reconstr Surg. 2014;30:219-224.
13.
de MaioMSwiftASignoriniMFagienS; Aesthetic Leaders in Facial Aesthetics Consensus Committee. Facial assessment and injection guide for botulinum toxin and injectable hyaluronic acid fillers: focus on the upper face. Plast Reconstr Surg. 2017;140(2):265e-276e.
14.
RoseAEDayD. Esthetic rejuvenation of the temple. Clin Plast Surg. 2013;40(1):77-89.
SasakiGHTevezA. Clinical efficacy and safety of focused-image ultrasonography: a 2-year experience. Aesthet Surg J. 2012;32(5):601-612.
17.
WerschlerWPWerschlerPS. Long-term efficacy of micro-focused ultrasound with visualization for lifting and tightening lax facial and neck skin using a customized vectoring treatment method. J Clin Aesthet Dermatol. 2016;9(2):27-33.
18.
ZelicksonBDKistDBersteinE, et al. Histological and ultrastructural evaluation of the effects of radiofrequency-based nonablative dermal remodeling device: a pilot study. Arch Dermatol. 2004;140:204-209.
19.
NahmWKSuTTRotundaAMMoyRL. Objective changes in brow position, superior palpebral crease, peak angle of the eyebrow, and jowl surface area after volumetric radiofrequency treatments to half of the face. Dermatol Surg. 2004;30(6):922-928.
20.
SasakiGTuckerBGastonM. Clinical parameters for predicting efficacy and safety with nonablative monopolar radiofrequency treatments to the forehead, face and neck. Aesthet Surg J. 2007;27(4):376-387.
21.
AlamMWhiteLEMartinNWitherspoonJYooSWestDP. Ultrasound tightening of facial and neck skin: a rater-blinded prospective cohort study. J Am Acad Dermatol. 2010;62(2):262-269.
22.
ChenSSWrightNTHumphreyJD. Heat-induced changes in the mechanics of a collagenous tissue: isothermal free shrinkage. J Biomech Eng. 1997;119(4):372-378.
23.
SterodimasANicarettaBKoytsouveliA, et al. Helium-based plasma radiofrequency technology for subdermal coagulation in the forehead: a preliminary, single-center retrospective study. Aesth Plast Surg. 2025;49:4131-4138.
24.
Lacerna KimbrellM. Helium plasma radiofrequency brow lift: description of a novel technique and retrospective study on safety, efficacy, and durability. Aesthet Surg J Open Forum. 2025;7:ojaf031.
25.
OthmanSCohnJEBurdettJDaggumatiSBloomJD. Temporal augmentation: a systematic review. Facial Plast Surg. 2020;36:217-225.
26.
GordonCRYaremchukMJ. Temporal augmentation with methyl methacrylate. Aesth Surg J. 2011;31(7):827-833.
27.
HirohiTNagaiKNgDHariiK. Integrated forehead and temporal augmentation using 3D printing-assisted methyl methacrylate implants. Aesth Surg J. 2018;38(11):1157-1168.
28.
LinJChen ZhangWXuLZhemgX. Temporal augmentation using a polytetrafluorethylene implant with the assistance of an endoscope. Aesth Plast Surg. 2010;34(6):701-704.
29.
FedokFGvan KootenDWLevinRJ. Temporal augmentation with a layered expanded polytetrafluorethylene implant. Otolaryngol Head Neck Surg. 1999;120(6):929-933.
HuangRLXieYWangW, et al. Anatomical study of temporal fat compartments and its clinical application for temporal fat grafting. Aesth Surg J. 2017;37(8):855-862.
32.
XieYHuangRLWangWChengCLiQ. Fat grafting for facial contouring (temporal region and midface). Clin Plast Surg. 2020;47(1):81-89.
33.
TzikasTL. Fat grafting volume restoration to the brow and temporal regions. Facial Plast Surg. 2018;34(2):164-172.
34.
LinZYangKLiGWeiSLiuY. Efficacy and safety of subcutaneous temporal autologous micro-fat augmentation. Aesth Plast. 2020;44:2098-2106.
35.
NasimSNasimHKaukeMSafiAF. Autologous fat grafting for cosmetic temporal augmentation: a systematic review. Front Surg. 2024;11:1410162.
36.
SundaramHCassutoD. Biophysical characteristics of hyaluronic acid soft-tissue fillers and their relevance to aesthetic applications. Plast Reconstr Surg. 2013;132(4 suppl 2):5S-21S.
37.
ChiangYZPieroneGAl-NiaimiF. Dermal fillers: pathophysiology, prevention and treatment of complications. J Eur Acad Dermatol Venereol. 2017;31(3):405-413.
38.
BorbaARodriguesM. Periorbital filling with the MD Codes™ algorithm: a narrative review and a practical guide. J Cosmet Dermatol. 2021;20(11):3398-3406.
39.
LemperleGde FazioSNicolauP. Artefill: a third-generation permanent dermal filler and tissue stimulator. Clin Plast Surg. 2006;33(4):551-565.
40.
LemperleGMorhennVBCharrierU. Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesth Plast Surg. 2003;27:354-366.
41.
LemperleGKnappTRSadickNSLemperleSM. ArteFill permanent injectable for soft tissue augmentation: I. Mechanism of action and injection techniques. Aesth Plast Surg. 2010;34(3):264-272.
42.
LemperleGRomanoJJBussoM. Soft tissue augmentation with Artecoll: 10-year history, indications, techniques, and complications. Dermatol Surg. 2003;29(6):573-587.
43.
Bellafill® [Instructions for use]. Tiger Aesthetics, LLC;2023.
44.
SundaramHWeinkleSPoznerJDewandreL. Blunt-tip microcannulas for the injection of soft tissue fillers: a consensus panel assessment and recommendations. J Drugs Derm. 2012;11(8):s33-s39.
45.
KrehCCRoiderLFirouzbakhtPK, et al. Artificial intelligence analysis of periorbital rejuvenation. Aesth Surg J. 2025;45(2):215-220.
TroellR. Permanent composite midface volume replacement: polymethylmethacrylate, silastic implants, and stem cell enriched fat grafting. Am J Cosm Surg. 2026:1-12.
48.
CohenSRHolmesRE. Artecoll: a long-lasting injectable wrinkle filler material: report of a controlled, randomized, multicenter clinical trial of 251 subjects. Plast Reconstr Surg. 2004;114(4):964-979.
49.
CohenSRBernerCFBussoM, et al. Five-year safety and efficacy of a novel PMMA aesthetic soft tissue filler for the correction of nasolabial folds. Dermatol Surg. 2007;33suppl 2:S222-S230.
50.
CohenSDoverJMonheitG, et al. Five-year safety and satisfaction study of PMMA-collagen in the correction of nasolabial folds. Dermatol Surg. 2015;41Suppl 1:S302-S313.
51.
KarnikJBaumannLBruceS, et al. A double-blind, randomized, multicenter, controlled trial of suspended PMMA microspheres for the correction of atrophic facial acne scars. J Am Acad Dermatol. 2014;71(1):77-83.
52.
ModarressiANizetCLombardiT. Granulomas and nongranulomatous nodules after filler injection: different complication require different treatments. J Plast Reconstr Aesth Surg. 2020;73:2010-2015.
53.
LehmanAPilcherBRobertsWESchlesingerTEVachonG. Postmarket experience of polymethylmethacrylate-collagen gel dermal filler. Dermatol Surg. 2020;46(8):1086-1091.
