Brow lift with or without eyelid lift

As in any job, cosmetic plastic surgeons often see the same plastic surgery condition again and again. I have written about brow lifts or forehead lifts in the past.

Brow lift  and eyelid photo

Today I want to tell you about the decision-making process a cosmetic surgeon uses to determine whether a cosmetic surgery patient with excess skin on the upper eyelids needs an eyelid lift, blepharoplasty, a  forehead lift or both.

Eyelid surgery

As we age, our eyelids, like other parts of the face, change due to a number of factors, including:

  1. environmental damage—sun exposure
  2. genetics—thinness of the skin
  3. individual factors —what your anatomy is like

The skin of the eyelids is the thinnest skin of the body, so the effects of aging are often seen there first, manifesting as drooping of the eyelids and herniation of fat from around eyes.

Cosmetic plastic surgery to correct eyelid droop is called a blepharoplasty. Cosmetic plastic surgeons will remove excess skin and fat from the upper and lower eyelids to give you a more youthful look.

Brow/forehead lift

With aging, foreheads will also droop, as brow muscles and skin become lax and allow a downward migration of structures. When the eyebrow is below the bony part of the brow, you have a droopy brow and may be a candidate for a brow lift! Drooping of the brow causes:

  1. lines between eyebrows
  2. horizontal lines across forehead due to over-activity of muscles trying to pull the brows up
  3. appearance of more skin and fullness of upper lids

Brow lifts include:

  • removal of excess skin of the forehead in the center of the brow and in the lateral areas of the brow
  • Elevation and fixation of the forehead muscles in a higher position

Evaluation of a patient for upper eyelid surgery or brow lift

When seeing a patient for facial rejuvenation of the upper facial area, I always start with the eyelids.

  1. I look at excess skin in the upper lids and feel the quality of the skin and see how much skin there is for excision. At the time of blepharoplasty, the excess skin is actually measured to the millimeter to be sure that not too much skin is removed and that the cosmetic patient will be able to close his or her eye!
  2.  I look at any extra fat that may be present around the eyelid. The upper lid has fat in two compartments. The first is along the width of the eyelid and the second in the corner close to the nose. Excess fat is removed during surgery.
  3. I lift up the brow and see how much of a difference that makes to the excess skin of the lids.
  • minimal difference to eyelid skin with brow elevation: there is no need for any brow surgery.
  • great deal less eyelid skin with this maneuver: patient may be a candidate for just a brow lift, as long as the brows are droopy.
  • eyelid skin is improved but not totally gone: cosmetic patient may be a candidate for both a brow lift and an upper eyelid lift.

A complete evaluation of the forehead and eyelid area is imperative for patients considering facial rejuvenation of these areas. It is important for patients to know that in some patients there is a significant contribution to droopiness of upper eyelid skin from a droopy brow, and cosmetic patients will not get the results they want if both areas are not addressed.

Morad Tavallali, M.D., FACS