Q: Dr. Eppley, I have some questions about facial asymmetry correction. After finally doing my research I have seen amazing reviews on you and before I make some big decisions, I am asking some help from the surgeon point of view. I have two questions I would like to ask.
1) Every time I take a photo and my phone flips it my face looks very asymmetrical and weird looking. What procedures from the photos I sent do you need to perform to look even?
2) How come when I ask my friends they don’t notice it with my eyes and eyebrows unevenly but in the photos I can notice it extremely.
Also I forgot to mention under my eyes too. Thank you.
A: Thank you for sending your pictures. When it comes to facial asymmetry correction it is first important to identify which facial features are the asymmetric ones. What I can gather from the one front view pictures is that you have significant eyebrow asymmetry. The right eyebrow sits lower than the left. Because a picture freezes the face for a continued assessment most facial asymmetries are easily seen. In real life the position of one’s face is constantly moving and rarely does one talk to someone dead on with a ‘frozen face’ so one can get a good assessment of facial symmetry or asymmetries. The treatment for eyebrow asymmetry would be a unilateral endoscopic browlift. This could be effective provided one has some eyebrow tissue laxity which can be assessed by whether you can manually raise up the eyebrow with your fingers.
Your undereye hollows are the result of deficient inferior orbital rim bone. While this can be treated by fat injections, it is probably best treated by infraorbital rim implants with an overlay of fat injections if needed.
Dr. Barry Eppley
Q: Dr. Eppley, I had an endoscopic brow lift to help lift my upper eye lids. Although I had an upper blepharoplasty done over three years ago, that surgeon not only did not remove enough skin to eliminate the ‘hoods’ over my eyes, he did not take precise measurements before surgery (he ‘eyeballed’ the distance, no pun intended, as if he was about to saw a piece of 2 by 4 wood). As a result I ended up with very little to show for that surgery – other than insufficient skin removed – and the brow lift was intended to correct this. Unfortunately, all that I appear to gotten out of the brow lift is two incision lines in my forehead (thankfully hidden – for now – in my receding hairline) and a couple of bumps in my forehead (where the dissolvable endotine ‘screws’ were presumably fitted). My middle brow (over my eyes) was not lifted. My upper lids are just as ‘hooded’ as they were before this surgery, and I am now being told that what needs to be done next is a revision blepharoplasty – a procedure I had asked about having done before the brow lift. It looks like I may have paid for what may have only been a ‘temporal brow lift’ and not a true middle brow lift, and I still need the revision blepharoplasty that I perhaps ought to have had done instead of this endoscopic brow lift.
A: The endoscopic brow lift, and in the results obtained, are highly dependent on the location of the scalp incisions. Where the scalp incisions are above the brows will determine exactly where the direction of maximal brow lifting is done. Unless the scalp incisions are directly in line above the medial brow areas, this area will not be lifted. In addition, in men, the effects of any browlifting is more modest. Thus any residual upper eyelid skin will not be removed and should be dealt with at the same time as the brow lift. It sounds like your case illustrates all of these points.
Q: Dr. Eppley, I had an endoscopic brow lift 2 years ago. It was pulled far too high and has formed what I can only describe as crater-like vertical depressions. This is so strange looking. I was so much better before with my normal horizontal thin lines. Is there anything that can fix this….is a reverse brow lift successful….could fillers wk….or hair transplant to cover the high long forehead?
A: One of the trade-offs for an endoscopic browlift is a longer forehead because this type of browlifting procedure is really an epicranial shift…it moves the scalp backwards to create the browlift below. The length of a patient’s forehead must be assessed beforehand and this effect considered when choosing any type of browlift.
The vertical depressions that you have are the effect of the internal fixation technique used to secure the uplifted scalp near or in the hairline. They are reflective of a really pulled up scalp and perhaps too aggressive browlift.
In terms of improvement, endoscopic browlifts can be partially reversed by the same method that caused the initial effects. Wide forehead and scalp loosening done through the same incisions as the initial operation may allow some reshifting of the tissues back to less stretched look. This may provide some improvement in the vertical depressions and partial lowering of the hairline. Fillers and hair transplants are also options to deal with the problems you now have but I would first try and treat the cause of the problem before exclusively treating the symptoms of the problem first. Those are always options if tissue loosening and reshifting is not entirely successful.
Dr. Barry Eppley
Q: I am a male who is considering having a browlift procedure. I am not sure how it is needs to be done but I do have one concern. Will a browlift make my hairline recede?
A: Browlifting in men poses unique concerns because of the varied and often absent frontal hairlines. Even in a male with a reasonably good hairline, it is impossible to predict what the hairline may do in the future. For this reason, the typical open browlift operations (either at the edge of the frontal hairline or behind the hairline) should be avoided. The endoscopic browlift remains the only ‘safe’ option even in a male with good hair density and frontal edge pattern.
The question of whether hairline recession make occur after a browlift is probably not directed towards actual hair loss from the procedure. This question likely relates to whether the hairline will move backwards as the brow is lifted. This is an excellent question and is a particularly relevant one in the endoscopic browlift.
This non-excisional (skin or scalp) type of browlift employs tissue shifting, or an epicranial shift, to create the effect of brow elevation. In other words, the entire forehead and scalp skin is shifted backwards, moving the excess tissue up and back where it sticks back down in a new position. As a result, the frontal hairline will move back to some degree. This creates some small amount of forehead lengthening, an increased distance between the brows and the frontal hairline. This is not hairline recession per se, just hairline repositioning.
Male patients in particular considering an endoscopic browlift should be aware of this hairline change. If the hairline is already fairly far back, this operation may not be a good choice or should be considered carefully.
Dr. Barry Eppley