By Paul S. Nassif, M.D., F.A.C.S.
Spaulding Drive Cosmetic Surgery and Dermatology
Like many of us, patient Barbara B. was tired of looking tired. Droopy eyelids made her look unapproachable, angry, and 10 years older than she really was. Plus, wearing makeup was becoming more and more difficult. A few years ago, Barbara decided that she was ready to take care of these problem areas and visited my office.
I suggested an endoscopic brow lift to raise her heavy brow, along with an upper eyelid lift to remove the sagging skin around her eyes. These subtle changes have left Barbara looking and feeling her true age and as young-looking as she feels.
Dr. Nassif's patient Barbara B. 33, shows the results of her
eyelid and brow surgery. The after pictures were taken
after her procedures. She also had lip augmentation and Botox
(Photos, courtesy of Dr. Nassif)
Excess and baggy, unwanted skin around the eyes is a common concern for many patients who want cosmetic surgery.
Excess Skin After Eyelid Surgery
An upper eyelid lift reduces the excess upper eyelid skin and muscle by making a fine incision in the crease of the lid. The sagging tissue is gently removed, along with the little fat pad in the corner of the eyes near the nose. The skin is then stitched back together. The eyelid lift, or blepharoplasty, helps to restore a more energetic and youthful look by making the eyes look more open and bright.
The brow lift procedure is very common, because as one ages, the eyebrows naturally begin to descend. That usually results in a tired look with fullness to the upper eyelids.
But in some cases, a brow lift can take care of this problem by elevating the brow.
Endoscopic Eyebrow Lift
Endoscopic brow elevation is done by making three to five small incisions hidden in the hair line. A tiny telescope is then used with small instruments on a thin cable to release the tissues of the forehead. Then, the eyebrows are brought up by using stitches in the temple area and sometimes with tiny screw fasteners in the bony part of the forehead, under the skin. The fasteners, known as Endotines, are absorbed by the body in about nine months. This is the most effective and least surgically-invasive way to elevate the eyebrows.
Often, many of my patients think they need an upper eyelid lift because of their droopy eyelids. Patients will visit a plastic surgeon and the surgeon recommends an upper blepharoplasty when, indeed, there is drooping in the eyebrows, and not in the eyelids.
Too Much Skin
In this situation, if an upper blepharoplasty is performed, the eyebrow-lid margin is potentially narrowed and the distance between the eyelash and the brow is shortened, which pulls the eyebrow down. The result is the patient sees no correction of the drooping upper eyelids.
As skin elasticity decreases, the forehead descends. Due to gravity, the brow, especially near the temples, descends to or below the rim of bone in which the eyes sit. This causes excess skin -- known as temporal hooding -- especially in the temple area.
Heavy Creases In The Upper Eyelid
The supratarsal crease is a crease in the upper eyelid that can often be seen in young patients but it disappears because of over-hanging, heavy, upper eyelid skin. Patients also notice that crow's feet begin to form next to their eyes. In addition, they start seeing heavy creases on the forehead, thanks to the effort of trying to elevate the heavy, drooping brow. Nonetheless, they feel that the eyelid skin is heavy, even though this is really caused by a heavy, low brow.
"Excess and baggy, unwanted skin around the eyes is a common concern for many patients…"
Proper screening by the plastic surgeon is paramount. Educating patients about the different surgical procedures and goals requires excellent physician-to-patient communication and guidance.
Computer imaging of the proposed brow elevation is also an excellent way to communicate and discuss possible outcomes with the patient. The initial examination is extremely important. When the patient first comes in, the doctor has to evaluate the patient's eyebrows in a relaxed state.
Natural Appearance After Eyelid Surgery
If the eyebrow is low, the doctor can bring it up with his fingers during the consultation and see how the upper eyelid skin corrects itself. Then, just by surgically elevating the eyebrow, a trained and experienced surgeon can restore the natural appearance of the upper eyelids without actually performing eyelid surgery.
Sometimes, if the patient has a normal eyebrow position, an ordinary upper blepharoplasty is performed and the eyebrow is pulled down. In this situation, I suggest performing an upper eyelid lift along with a conservative brow lift. This won't pull the eyebrow down when the blepharoplasty is done. In situations where the eyebrow is low and there is extra eyelid skin, the doctor should perform both the brow lift and an upper blepharoplasty.
One of the other procedures I'm performing to help create a youthful-looking brow -- and also lift the brow -- is via fat grafting to the brow. The fat grafting keeps the brow area looking natural and rejuvenated. This may also help keep the eyebrow elevated during the healing process.
For an improved appearance, Botox can be injected into the forehead in about three months after the patient is healed. Fat injections can be used on the brow with or without brow lift surgery, although more lift is obtained with the brow lift.
"Often, many of my patients think they need an upper eyelid lift because of their drooping eyelids…"
Overall, vigilance by the plastic surgeon during the examination and educating the patient is paramount. Making sure you see a board certified facial plastic or plastic surgeon is the key to obtaining an excellent result.
Also, on the doctor's web site, be sure to look at the before and after photos that show the procedure you have in mind. Make sure that the results after the procedure are natural-looking and that the consultation with the physician is informative.
Dr. Paul S. Nassif is a rhinoplasty specialist and facial plastic surgeon. He developed, "The Anti-Gravity Facelift," which leaves no visible scars and is noted for achieving natural-looking results in the shortest recovery time. He has authored numerous peer reviewed articles on facial plastic surgery and has given medical conference presentations and lectures about the latest surgical techniques. To promote a better understanding of the benefits and comfort of cosmetic surgery, Dr. Nassif has been featured on E! Entertainment's "Dr. 90210," NBC Nightly News, BBC, Inside Edition, CBS Health beat, Entertainment Tonight, NBC's Today Show, and EXTRA.