Brow Bone Reduction
Q: Dr. Eppley, My primary cosmetic concern is actually very dark skin in the upper and lower lids as well as the sides of the nose. Unfortunately, without make-up this feature dominates my face. However, I am also aware of some structural issues that make this darkness look worse. My prominent brow bone casts a shadow over my deep-set eyes and that the radix of my nose is very narrow. Would you agree that these are contributing factors? (Photos, with make-up, are attached.) Would brow bone reduction and nasal augmentation help?
I had some fat transfer to the lower lids ten years ago with some lasting success. I would now like to correct the darkness in my upper lids and medial canthus and I’m researching two options. One option is fat transfer. The other is to address the structural issues through reduction of the brow bones and lateral augmentation of the radix of my nose. Ideally, I would pursue all of these (along with hairline lowering) but am hesitating to have such invasive procedures.
Can you advise me which of these procedures will make the most difference to the darkness in my eye area and my overall appearance? Also, what is the likelihood of a good result? Any advice you can offer is greatly appreciated.
A: Thank you for your inquiry and sending your pictures. While your structural issues may make a contribution to your periorbital dark skin appearance, you would never do structural surgery such as brow bone reduction or nasal augmentation in an effort for skin coloration improvement of the adjoining areas. The risks are simply too high. You do those surgeries for what they primary purpose is…creating a structural change not a potential secondary benefit.
This leaves you with the only treatment option of which you have had prior experience…fat grafting. Whether this would be effective to improve your periorbital skin discoloration is not precisely known.
Dr. Barry Eppley