Q: Dr. Eppley, I have some lateral brow questions.
1) What are the most common complications or patient complaints associated with a lateral brow lift in your practice? Are these permanent?
2) Will the temples/forehead be numb after a lateral brow lift?
3) Approximately how many millimeters of lift can I expect?
4) Will my hairline be lifted? If so, how much?
5. I just wanted to confirm that the tail and some portion of the arch/point of the brow are adjusted – meaning the brows aren’t just lifted at the bottom of the tail causing the brows to become straight/flat… It seems from looking at online pictures the results vary greatly from surgeon to surgeon so I am guessing there is room for some tailoring to the patient in the operating room.
A: In answer to your brow lift questions:
- The most common issues after a lateral or temporal browlift procedure are adequacy of the lift (how much lift was achieved) and the potential for widening of the scar in the temporal hairline.
- I would imagine that there is some temporary numbness of the skin in the direction of the temporal browlift but that is not an issue that I hear patients mention.
- The amount of lift obtained from a temporal browlift is variable, anywhere from 2to 3 mms to 5 to 7mms.
- While the hairline should be lifted as much as tail of the brow, the distance between the hairline and tail of the brow stays the same…thus it is not really noticed.
- Temporal browlift results are indeed highly variable and it is not an exact science. The fundamental problem with this technique is that the best and most predictable way to do it (making the incision along the front edge of the temporal hairline and excising skin doing the lift there) is rarely where the patient can accept the scar line. Thus putting the incision back in the temporal hairline is usually necessary and this is where the lift becomes less effective. To make it effective the incision and skin removal has to be bigger because the point of lift is further away from the brow.
Dr. Barry Eppley
Q: Dr. Eppley, Is it possible to do forehead lift to rid of horizontal wrinkle lines and raise the forehead but not move eyebrow position? Because I have many forehead wrinkles. I have tried Botox but I want a permanent result. I don’t want any movement position in eyebrows. How is it done?
A: What you are asking can not be done exactly the way you want it. You can not permanently paralyze the entire forehead even with extensive muscle stripping. And if you remove all the muscle between the eyebrows to try and achieve it you will need up with a dent or depression between the eyebrows. You definitely can weaken it considerably by muscle resection (glabellar area) but it should be combined with the placement of a dermal-fat graft in the resected area so that a depression is not created and it will inhibit any muscular reattachments as well.
In reality a forehead lift and a browllift are one and the same. A forehead lift can not be done without some browlifting effect. That effect can be made minimal but no change can be done in the forehead without some potential change occurring in the brow area riught below it.
Dr. Barry Eppley
Q: Dr. Eppley, I have very heavy looking eyelids. Would I be a good candidate for an endoscopic browlift or an eyelid lift? I have some concerns about making my forehead higher.
A: Your question is not an uncommon one as many people with ‘heavy’ upper eyes do have a combination of some degree of brow ptosis and redundant upper eyelid skin. In looking at your pictures, I think your heavy upper eyelids do fall into this ‘combo’ category and are caused by a combination of slightly low brows and upper eyelids that have too much fat and just a touch of extra skin. The question is whether a browlift alone (pretrichial not endoscopic so your hairline will not only not get longer but can even be lowered if desired), some upper eyelid skin removal and defatting or both would be optimally beneficial.
This type of periorbital decision can be difficult as you do not want to over operate but, by the same token, you do not want to under treat either.
Dr. Barry Eppley
Q: Dr. Eppley, It has been determined that I suffer from brow ptosis by my general doctor, he had recommended orbital rim contouring and a browlift to alleviate the issue and prevent it from happening in the future. I have also checked with my insurance company and they have stated that both procedures would be covered if deemed medically needed by the surgeon of my choice. I would love to be able to submit pictures if needed to assist you in diagnosing brow tosis on your own and would love to hear feedback. I was hoping it would be possible to request that the brow bone can be shaven to a more feminine contour. Please let me know if you are interested in helping me pursue treatment and are able to accept insurance or if we need to make an exception!
A: While there is no question that brow contouring can be done to create a more feminine appearance with or without a browlift, the issue of potential insurance coverage for it is almost certainly not. It is important to understand that when a patient calls up their insurance company, the standard unqualified answer is always ‘if your doctor says there is a medical reason for it, it will be covered’. Unfortunately that person and the section of the insurance company that they work for has nothing to with the department that actually approves the surgery and issues payment for it. That is the Predetermination section and they are tasked with determining whether there is any medical reason for the surgery. The only medical reason for a browlift is upper visual field obstruction and this must be substantiated with a visual field test. This must accompany a predetermination letter on which they will pass judgment about medical coverage. If they deem it is medically necessary based on the evidence, a browlift may be approved as a medical procedure. Any orbital rim/brow bone reduction/shaving never has a medical reason for it being done and is always deemed a cosmetic procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I am a middle-aged man who have been considering elective surgery for a long time. Due to my temple hollowness, I have had injectables (Radiesse, Sculptra, fat) in the area for long time, but with very limited effect and minimum duration. I am looking now into a more permanent solution, like temporal implants. On the other hand, due to my “sad look” a lateral brow lift has been offered to me several times, however, do you think that correcting the temples could fill up the area around the orbital contour or a lateral brow lift could still be needed? If so can both procedures be done together? My separate question to you is to whether a facelift could be performed at the same time as the one or the two procedures discussed above. Thank you in advance for your reply.
A: Temporal implants would be the only effective treatment option with your type of temporal hollowing. Your thin facial tissues have little fat and this explains why any type of injectable filler, including fat, can persist. Subfascial temporal implants will provide a permanent result by muscle augmentation. Temporal implants will not lift up the tail of your brows, n matter the size. That will require a temporal browlift, best done in men through a transpalpebral approach using an endotine fixation device. A facelift can certainly be done at the same time with careful placement of the incisions around the ears.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested on finding out if a browlift I had done can be reversed or a brow lower ing procedure be done. About one year ago I had an aggressive endoscopic browlift done in which afterwards has lifted my eyebrows way too high. I only had a minor brow sagging problem beforehand and was borderline for the procedure anyway. My surgeon told me they would eventually drop but have not done so and if they have it is clearly not enough. I look like the proverbial ‘deer in the headlights’ look compared to what I looked like before surgery. Can this overdone browlift be fixed in your experience?
A: Excessive brow elevation from an from an overdone browlift can be treated by observation for 3 to 6 months or a brow lowering procedure. Most overlifted brows will usually relax to an acceptable level. But if not, a brow lowering procedure can be done with a subgaleal dissection release combined with an intraoperative tissue expansion manuever. Using a small tissue expander placed in the mid-forehead, it is inflated to its maximum volume to aid with the subgaleal release. Done together, a browlift can be reversed.
Dr. Barry Eppley
Q: Dr. Eppley, I think I am interested in a browlift. Recently I have seen major changes to my face. I have been very lucky to always have been told I look younger and more youthful than I am but time has finally caught up with me. As you can see my eyes look tired and I look puffy. I also have always had a duck lip! I tried fillers but as you can see it made it worst. I am looking forward to looking refreshed and as young as I feel. I have started a six month lifestyle change, going to the gym three to four times a week, cutting out sugar and smoking over the next couple of months and studying natural/ holistic food. I feel beautiful until I look in the mirror and I know the potential I could be with a few minor adjustments. I am interested in seeing if you can see this too! I never expect to be a model but would like that twinkle in my eye again. I am looking forward to reviving my youthful look. Looking forward to hearing your suggestions.
A: As all of us age the first changes that are seen are around the eyes. Excess skin develops on the upper eyelids, the lower eyelids become puffy and, for some, the eyebrows drop. Rejuvenation of the aging periorbital region could include upper and/or lower blepharoplasties and browlifts, depending upon which areas are of the greatest concern.
Based upon the one picture that you have sent, it is hard to say what the ideal procedure (s) is for around your eyes since it is only a side view. The upper eyelids shows a little bit of excessive skin, the lower eyelids may actually have some tear troughs and the brows may or may not be low since I have no idea what you looked like years ago. My suspicion is that maybe a browlift and little skin removed from the upper eyelid and fact redistribution on the lower eyelids may suffice…but a few more pictures would be helpful.
For the upper lip protrusion, I would have expected injectable fillers to have made it worse. You would be better served with an upper lip lift which would reduce the protrusion somewhat but also give the upper lip a little more fullness. But again a front view picture would also be helpful in deciding if a lip lift will really be beneficial or not.
Dr. Barry Eppley
Q: Dr. Eppley, I had a craniotomy for an aneurysm over a year ago with radiation. This has left me with many effects from facial nerve paralysis. It has affected my face from the brow the whole down to the neck with a facial droop. I have attached pictures for your assessment. When I lay down my right eye does close which it did not do for quite awhile. The only movement I have on my right temple is a slight lift of the inner tip of the eyebrow. When I try to wrinkle my brow it goes slightly past center but it curves downward. The corner of my mouth was much further down than now. Originally there was no movement at all. I am now able to turn the corner up and the area of movement still seems to be increasing.
A: Thanks for sending your pictures. What they indicate to me is the following:
The frontal branch of the facial nerve is gone which is why the eyebrow does not lift up. As long as the eyebrow has not drifted lower than the opposite normal left side, I would not do any procedure for it. (i.e., browlift)
It is good news that the upper eyelid does now nearly close. As long as it closes completely when you lay down, I would not place a gold weight in the upper eyelid which is the normal treatment for a partial or slow closing upper eyelid.
The lower eyelid, as previously mentioned, needs a procedure which will help it considerably. It needs to be lifted and tightened up against the eyeball. To achieve this more is need to be done than just a traditional lateral canthoplasty. (tightening the lateral canthal tendon at the corner of the eye. That procedure needs to be combined with a fascial sling (harvested from the temporalis fascia) that would be placed from one corner of the eye to the other, much like a clothesline. Together this is the most effective method for lower eyelid tightening and resuspension.
The right face and lower corner of the mouth appears to be in some state of gradual improvement although it is probably not realistic to think that completely normal mouth movement will ever occur. However,, as long as it is improving, I may defer any type of static corner of mouth resuspension until later although that is still up for further evaluation.
The entire right facial droop may be treated with a complete facial resuspension (facelift) on the affected side. That is certainly reasonable to do at anytime. This may be combined with a corner of the mouth lift, both of which will not negatively impact any ongoing facial nerve recovery.
The right temporal area is sunken in due to the effect of the combined craniotomy and radiation, which has caused the temporalis muscle to shrink or atrophy. This is a very common effect from this exact neurosurgical procedure. The temporal area could be built back up using a variety of techniques which would depend on the dimensions of the volume lost. I can not tell exactly from the pictures to give you a better idea on how that would be done yet.
Dr. Barry Eppley
Q: Dr. Eppley, do you ever do a forehead burring/scalp advance/brow lifts without the sinus setback? I am a woman and my brow bones are not that big so I don’t think I need the frontal sinus setback.
A: Most forehead reductions in women are actually done by burring and not osteotomies/sinus setbacks. That is more of a male procedure in most cases. In women it is common to do a brow bone reduction by burring and/or forehead reshaping with a hairline advancement (scalp advancement) or a browlift. Seeing some photos of you would be helpful in determining which are the desired procedures.
Dr. Barry Eppley
Q: Dr. Eppley, First I must say I’m very impressed with your forehead contouring method and I think I come to the right place for my procedure. I am an Asian male who had goretex custom implants placed for brow bone augmentation via a bicoronal incision and fixed with screws. From beginning I was unsatisfied with the result. It gave me extreme brow ptosis with a paralyzed left eyebrow that interferes with my vision. I can not raise my left eyebrow at all. The paralyzed left eyebrow seems like it is caused by implant placement which is placed slightly higher than the right eyebrow. I know because I can feel it. The brow ptosis dramatically changed my youthful eyes shape and made me like an old tired man. I have to keep raising my eyebrow muscles constantly everytime I meet people to make my face look ‘normal’. It has been three years since this surgery and I don’t want to look this way anymore. Now I’m considering brow lift to help my issue. Am I good candidate? What is the best brow lift method to address my complex issue? I tried to avoid bicoronal incision again because it left me with 1 cm width scar ear to ear with no hair growth at all in that area. I even want this ‘bald’ scar removed if possible. Can this brow lift method change my youthful eyes shape back like before?
A: To lift your brows now, the only option would be to re-use your bicoronal incision. The good news is that the scar needs to be excised anyway to obtain a substantial narrowing of it. That scar is unacceptable. That would work in helping with the browlift since the amount of brow movement upward should be roughly the same amount as the width of the scar that needs to be removed. I believe this will be successful. Whether it will get the brows elevated as much as you demonstrate with your hands may be overly optimistic but much improvement should be obtained.
As an aside, I suspect your left eyebrow paralysis is the result of an injury to the frontal nerve branch of the facial nerve on that side from the raising of the bicoronal forehead flap. It would be unlikely that the eyebrow doesn’t elevate because it is ‘stuck’ on the brow bone implant.
Dr. Barry Eppley
Q: Dr. Eppley, I have indentations on my forehead. On my right side, there is less volume so I have more loose skin and my eyebrow droops. I would like to get the indentations filled in so my forehead looks smoother. Since filling out the area would make my skin more taut, would it fix my eyebrow into a more normal position so it doesn’t droop anymore? My brow bone is also smaller on the right side. Could bone cement build up my brow bone? If so, could that also help lift my eyebrow up? If some skin removal is also necessary, would it cost a lot more?
A: Forehead augmentation (onlay cranioplasty) by virtue of adding volume would potentially make the skin tighter. There may even in some cases be a slight browlifting effect, although this would be greatest with the brow bone is directly built up. Whether this would occur or not would also depend on how much volume is added. To ensure that this stretching and lifting effect occurs, it would usually be best to do a browlift with the forehead augmentation. This would be easy enough to do since there would be a coronal incision already present. It would not add any appreciable time or expense to do so because of then existing scalp approach for the forehead augmentation.
Dr. Barry Eppley
Have you ever looked in the mirror and seen that tired look and wondered why? If you are over forty, this might be a near daily occurrence. Fullness or extra skin of the upper eyelid is one of the most common causes of tired looking eyes. You may be wondering what’s the best way for me to remove this fullness and restore the youthful, attractive look to my eyes. Is it an eyelid lift (blepharoplasty), a browlift or some combination that is right for me?
Fullness and heaviness of the upper eyelids occurs for two reasons. The most common reason is too much skin and fat. Due to the constant stretching of opening and closing your eyes (the upper eyelid accounts for most of eyelid closing) extra skin is created over time. Eventually this can become so significant that it hangs down onto your eyelashes, known as hooding. The other contributing reason can be the position of the eyebrows. If the eyebrows have dropped down and are too low (gravity does usually win) this can also add fullness to the upper eyelids as it pushes the eyelid skin down.
To really know whether it is the eyelid skin, the eyebrows or a combination of both that is causing those full and tired looking upper eyelids, you must do an eyebrow placement test. By putting your eyebrows in the proper aesthetic position (by pulling up on the forehead skin until you have the desired eyebrow position) and then opening and closing your eyes, one can see the true amount of upper eyelid fullness remaining. By so doing, there are three possibilities for correction which will be revealed.
When the eyebrows are lifted to a better position, all the upper eyelid fullness is gone. This means the fullness is due to low eyebrows and the solution is some form of a Brow Lift. In this situation if only an eyelid lift was done, it would actually cause your eyebrows to become lower.
When the eyebrows are lifted, some but not all of the upper eyelid fullness gone. This means a combined browlift and eyelid lifts are ideally needed. It would also be perfectly appropriate to just do an eyelid lift and accept the lower eyebrow position. For men this is usually more common than in women as most men have naturally lower eyebrows.
If the eyebrow is already in a good position on the lower end of the forehead and all of the eyelid fullness remains, than only eyelid lifts are needed. This is , by far, the most common tired eye scenario particularly if one is under the age of 55 or so.
Plastic surgery correction of aging of the upper eyelids must consider its upstairs eyebrow neighbor to determine the best solution to a less tired and rejuvenated look.
Dr. Barry Eppley
Q: Dr. Eppley, I have a question regarding browlift surgery. I have a low hairline which is only about 2 inches from my eyebrows to my hairline. Would a browlift/forehead lift increase my forehead length and can this be done without moving my eyebrows higher. I am young but I have a lot of laxity in my forehead. Thanks!!
A: The simple answer is…no. You can’t lift/stretch the forehead skin upward without moving the eyebrows to any significant amount. Since the whole forehead skin must be loosened to get any movement, the eyebrows will naturally be raised although not to the degree that the skin is lifted since they are the furthest away from the location of the pull. You might get a half inch up to an inch if your forehead is really lax but no more. Browlifts, by definition, raise the eyebrows.
It is possible to really lengthen your forehead through tissue expansion but this is a two-step surgical process. This is where a tissue expander is initially placed under the forehead skin during the first procedure. This is gradually inflated by saline injections over four to six weeks to make the forehead skin ‘grow’. Once adequately expanded, the tissue expander is removed and the forehead lengthened with the extra skin created. This can increase the forehead skin length by several inches if desired.
Dr. Barry Eppley
Q: For most of my life I have considered myself ugly. I avoid having pictures taken and I most certainly don’t look at them if they have to be taken. I have a total lack of confidence and this has definitely poses problems in my personal relationships. I don’t know what it is about my face but it just doesn’t look right. I am only 29 but I look much older. My eye area looks droopy and old and may face looks thin and distorted. I have attached some pictures for you to see and review. What would you recommend to help me look better ?
A: When someone doesn’t like their face, particularly at a young age, this indicates that the problems are with how it is put together (structural components) not that it is has early aging. This means the underlying structures that make up the shape and highlights of the face which are largely bone and cartilage. In reviewing your pictures, I can see that your face has unbalanced structures which include low hanging brows, a broad and prominent nose, hollow cheeks, and a wide and long chin. The combination of these features creates an overall facial look that you do not like. Procedures such as an endoscopic browlift, rhinoplasty, cheek implants and chin reduction collectively would make a major change in how your face looks. It would lend a softer and more youthful due to a better balance of your facial features. Computer imaging with these changes would demonstrate their potential benefit in changing the shape of your face.
Dr. Barry Eppley
Q: I am 30 yrs old and am tried of people telling me that I am in my mid to late 40s. Ugghhh! I usually just walk away and cry and I am tried of crying over this and want to get something done about it. I have had a brow lift and a neck liposuction about 2 yrs ago. I would like to see what it would look like with eyelid lift and filler. Would you also recommend something else? Maybe a chemical peel? Thank you for your help! I really appreciate it!
A: Thank you for sending your pictures. Unfortunately computer imaging is good at changing structures of the face but not very good at soft tissue manipulations such as those that you have asked for. An eye lift can not be done as it distorts the whole eyelid. However, I think there is no question you have upper eyelid hooding and you would clearly benefit by an upper blepharoplasty or eyelid lift. Putting in fillers along the nasolabial fold and lips is also not very accurate and often just distorts the lips in trying to image it. You have reasonable lip size so injectable fillers will make them nicely bigger. As you have suggested, a chemical peel is good for skin texture and brightening the glow of the skin and for fine wrinkles as well.
As for other recommendations, I have done some other changes just to look at how to soften your facial features and make your face more ‘youthful’. These have included the following:revisional browlift to lower hairline (reduce long forehead) and correct existing brow asymmetry, rhinoplasty to make nose look slimmer and more narrow and chin reduction to soften chin point and make softer looking.These are structural facial changes which are different than just anti-aging procedures.
Dr. Barry Eppley
Q: For my bulgy forehead, is it possible to burr down the forehead and then do a forehead/eyebrow lift at the same time, just removing the extra skin? The reason I ask is because my head is misshappen and my hairline is too high. I want my hairline to be lower so burring down some of the forehead and then making and eyebrow lift would help alot. After that is done I was going to get a hair transplant on my hairline to cover up the scar. Does this sound like it will work? Will it work if I get a hair transplant over the scar and can I do the eyebrow/forehead lift thing?
A: Your approach to a forehead or frontal contouring is conceptually correct. While I don’t know exactly where your exact hairline is now or what its shape is, making a scalp or coronal incision there allows one to access the forehead area. Probably about 5mms across the forehead bulge can be taken down. A browlift can then be performed and the redundant skin removed at the scalp incision line. This will shorten the perceived length or height of the forehead skin. Thereafter, no more than 3 to 6 months later, a hair transplant can then be done to put a camouflage to the scar. Such a scar in the scalp can often heal remarkably well due to the uniqueness of hair-bearing (or past hair-bearing) scalp skin.
Dr. Barry Eppley
Q: Dr. Eppley, My droopy eyelids are driving me crazy. While I have always had very fleshy and heavy eyelids, they have gotten worse as I age. After my 40s (I am 55 now), they began to sag badly. Putting on makeup has become very difficult. What’s even worse is that it is making my forehead wrinkle. My eyelids are heavy and they seem to be in the way of me seeing. Without realizing it, I tense my forehead muscles to lift my brows up. This lifts up some of the eyelid skin and makes me see better. All of this forehead muscle tensing has given me permanent creases in my forehead. Should I just have my eyelids done or both my eyelids and my forehead?
A: Droopy and heavy eyelids, besides interfering with you seeing, can make you look sad and tired. Blepharoplasty (eyelid lift or tuck) can open them up dramatically and give you a fresher and more alert appearance. (some call it a youthful change) That is certainly what you would benefit from as you have realized.
A browlift is a good complementary procedure to blepharoplasties if your brows have dropped with age. Lifting one’s brows up can signify that it is either a reaction to drooping eyelid skin or that the brows are too low as well. That is an important distinction to make. I suspect that it is more of a reaction to your eyelid skin issue. Therefore a browlift is not what you really need. More likely you would benefit from Botox injections to ‘detrain’ your forehead muscles from the muscular responses they have now learned to do.
Dr. Barry Eppley
Q: I have noticed that some fat has developed above the very top of the nose between my eyes. I have attached a picture of it. It seems to be getting thicker and heavier as I age. Is it possible that I am growing fat between my eyes? I have never heard of such a thing. Is there nyway of getting rid of this?
A: The ‘fat’ to which you refer between your eyebrows is not really fat. It is thick heavy skin and muscle, which over time and with age and continuing facial expression, has fallen downward into the glabella (area between the eyebrows). This creates a bunching of tissue and skin folds which looks like fat to you but is just sagging tissues from age and gravity. Its correction would require some form of a browlift to both thin out the overactive muscle in this area and to lift the sagging brows and forehead tissue which is pushing it downward.
Dr. Barry Eppley
The eyes may be the window to the soul, but they also create a strong impression of how we look. So many people comment to and about others based on how their eyes look. We all have had the experience of someone asking us if we are tired or have been up late. You can be certain their question is not probably based on how we were dressed or what we were eating.
But it is not the eyes per se that give these impressions, it is what is around them. The drapes of the eyes, the lids or window shades, are largely responsible for their appearance. Too much skin, deepening wrinkles, and bulging fat creates a tired and aging appearance. When combined with falling eyebrows, the amount of eye we see gets smaller and one really does look older. All this excess lid tissue is also prone to collect and retain fluid, hence those swollen eyes in the morning.
Because of the impact of how our eye area looks, eyelid surgery (blepharoplasty) is the best value in all of facial rejuvenation surgery. This is certainly true based on the size of the treated surface area. But more importantly, changing the look of the eyes does exactly what one is after…to look more refreshed. Few want to look different, but all want to look like themselves, only better.
While there are some non-surgical treatments that can make some areas around the eyes look better, none of them can improve the way the eyelids look. Botox can decrease wrinkling between the eyebrows and around the sides of the eyes, and that can be a great benefit for sure, but that affects expression only. If you look in the mirror without your face smiling or moving and your eyes still look tired, eyelid surgery is the only option.
By the way, forget about some magical cream making your eyelids look better. Amongst the many hundreds that exist, a few can make some minor reduction in fine wrinkles and puffiness. But really visible differences require removal of what makes them look that way, too much skin and fat.
While blepharoplasty surgery works on the lid skin, there are differences between what is done on the upper versus the lowers. The upper eyelids are largely about skin removal and re-creating an upper eyelid crease. Having a well defined eyelid crease is more important than trying to remove all excess skin. In the lower eyelid, more focus is on fat removal and skin tightening and making it as smooth as possible. There is no lower eyelid crease that needs to be made.
Many potential patients fear that blepharoplasty surgery will make them look unnatural. While this is possible if too much skin is removed from the eyelids, most overdone results come from browlifting not blepharoplasty. While browlifting can be a valuable addition to eyelid tucks, it is a procedure that is easily overdone. High eyebrows can easily change the appearance of the eye area and not favorably. Consider browlifting very carefully. It is not a cavalier addition to eyelid surgery.
If you are tired of looking tired, blepharoplasty may be a good choice to get a more youthful look back.
Dr. Barry Eppley
One of the first signs of aging is what happens around one’s eyes. We are so expressive with our eyes and forehead that they bear the brunt of much of the early and visible signs of the aging process. How many times has someone said to you…are you tired?…have you been working late?…when in fact you just had eight hours of sleep. The development of extra eyelid skin, lower eye bags, and wrinkles around the eyes can be telling.
This makes the blepharoplasty (eyelid tucks) a vital plastic surgery procedure in making one look more refreshed. Many patients fear, however, that such an eyelid procedure will change their appearance rather than just making it more youthful or rejuvenated. This fear is promoted by just looking at today’s over-operated celebrities who have had too much surgery, or overly aggressive surgery, and look very unnatural. Such changes do make one look different, but not better.
Modern blepharoplasty surgery avoid these problems using a more conservative approach based on a better understanding of how the eyelid and face changes with age. Greater emphasis is placed on not disturbing the eyelid’s complex system of support and removing just the right amount of extra skin. This leads to a more natural looking result that does not alter one’s appearance.Baggy upper and puffy lower lids can now be treated with less tissue disruption and scarring for a safer and more natural long-term result. The goal is to look like yourself…just better!
When considering an upper eyelid procedure, the position of the eyebrow must be considered. A low hanging eyebrow can make it look like there is more skin in the upper eyelid than really exists. A browlift procedure is occasionally done with a blepharoplasty when it is determined that a higher brow is aesthetically beneficial. How do you know if your eyebrow is too low? That would depend on where one’s brow was when they were young. I would submit that most people do not remember where it was in their younger days. You simply have to play with it in the mirror to decide if higher is better.
Browlifts are primarily a procedure for women, they are rarely done in men. When browlifts are done, emphasis should be on more lateral brow elevation and less inner brow elevation. A woman’s eyebrow usually has an upward and outward sweep to it towards one’s temple area. Bringing up the inner part of the eye brow is what creates an unnatural overelevated look.
Today’s in-office ‘needle’ treatments can also provide some around the eye area improvement. Botox (and Dysport), not injectable fillers, is what is used. It is a great treatment for reducing the frowning look between the eyebrows, horizontal forehead lines, and crow’s feet wrinkles at the side of the eyes which can be particularly evident when one smiles. As an early treatment before significant eye aging changes occur or as a complement after blepharoplasty surgery, Botox is a simple and cost-effective non-surgical treatment.
One no longer has to be told that they look tired or are seeing their eyeball slowly disappear in a sea of loose and hanging eyelid skin. Between the three Bs (blepharoplasty, browlift and Botox), a more rested and refreshed you awaits!
Dr. Barry Eppley