“Correcting the Upper Eyes”
The Brow Lift or Forehead Lift is a very important addition to an Upper Eyelid Blepharoplasty for correcting tired eyes. Excessive Eyelid Skin is more often than not caused by laxity of the Eye Brow.
Lateral Hooding (Drooping of the Outer Eyebrow) indicates a need for a Brow lift
After an Endoscopic Brow Lift, the eye looks open and youthful in appearance
Brow Lift: How I like to do it
If it appears your eyes are drooping, feel heavy and you see puffiness, bags or looseness in the skin around the eyes, your probably ready for a Brow Lift and/or Eyelid surgery.
Let’s first understand the characteristics of the eye most of us find pleasing.
- In a female the eyebrow should be high and arching.
- There are many different shaped eyebrows, but most commonly the highest point of the brow begins directly in line with the outside edge of the iris. However, the highest point of the arch can begin further outward.
- The upper eyelid should show a nice deep crease. This can vary, but is usually about 1 centimeter above the lash line.
- The lower eyelids should be free of bags, loose skin and should tilt upwards as the lid moves towards the outside edge.
When I Am Evaluating Your Eyes
I will look for lateral (outside) hooding.
Lateral hooding is due to ptosis (sagging) of the forehead and eyebrow. It causes a flattening and loss in the height of the arch, with a loss of the visible eyelid crease on the outside edge. The lateral hooding or curtain of skin may actually impair your ability to view objects when gazing upward and outward. To overcome this visual impairment, you may unknowingly raise your eyebrows, which can create deep wrinkles in your forehead.
Because ptosis (drooping) of the eyebrow is so common, it is essential to determine if lateral hooding exists before performing upper eyelid lifting. If you have ptosis, then upper eyelid surgery should not be done without a Brow Lift, otherwise, the surgical results can be less than you expected.
Unfortunately, this is the most common mistake made by those performing eyelid surgery. This results in further lowering of the eyebrow from the pre surgical position, a less visible eyelid crease and early recurrence of the original problem. Upper eyelid surgery by itself should be preserved for those who have a good eyebrow arch and no lateral hooding.
The Brow Lift is an excellent procedure to achieve a more youthful appearance in your eye area. It has very little postoperative pain associated with it and a quick recovery time.
Endoscopic Brow Lift
The Endoscopic Forehead Liftis my favorite technique, because it requires no removal of hair or skin and maintains the hairline at a similar level. Through a few small incisions hidden in the hair, an endoscope (similar to an arthroscope used by the orthopedic surgeon) is passed under the skin and the eyebrow attachments are repositioned higher. This new position is maintained for several days with sutures and bandages. Most of the time it is necessary to remove excess upper eyelid skin at the same time as the Brow Lift. The endoscope can also be used to correct frown lines between the eyes and unlike BOTOX, is permanent.
Coronal Brow Lift
The Coronal Forehead Liftis performed by making a long single incision in the scalp. Because this incision is more likely to be seen and will raise the hairline, I will reserve this type of Brow Lift if you have thick enough hair to hide the incision and a low hairline that would look better in a higher position.This Coronal Brow Lift can be used to remove part of the forehead muscle responsible for creating forehead wrinkles.
Lower Eyelid Surgery
Blepharoplastyis performed to tighten the loose skin and remove the bags under the eyes. There are two types of incisions. The most common is the Subciliary incision, just under the lashes of the eyelid. A second type of incision is the Transconjunctival incision, inside of the eyelid. This trans-conjunctiva incision removes no skin and addresses only the bulging fat pads.
Since there is no removal of skin, this procedure is best done if you are in your late 20’s or 30’s. Sometimes it is combined with a Laser to help tighten any loose eyelid skin that is present. If a Laser is being used, caution must be taken not to apply the laser energy to the wrong skin types, which might result in permanent color changes to the skin. There are 3 fat pads in the lower eyelid which can be repositioned during the Eyelid Lift if bags exist.
General Information about Brow Lift Surgery
- Length of surgery – 1-2 hours
- Anesthesia – General
- Same day / Out patient surgery
- Pain = Moderate
- Time off work – days to 2 weeks
- Restricted Activities for 4 weeks
- Bruising and swelling possible for 2 weeks
- Avoid squinting and sunlight for about 4 weeks