The truth is that we have been doing too many brow lifts...

The truth is that we have been doing too many brow lifts. If you look at beautiful young models, most of them have low brows! Raising the brows in many women just makes them look different, not younger.

So, you have to make the right diagnosis. If the eyebrow is at the level of the bone above the eye, the patient does not need a brow lift. I just do an upper blepharoplasty which mostly consists of removing redundant skin. The inside of the eyebrow almost never needs to be raised.

So, if a patient's brows are below the level of the bone, then I perform a lateral or outer brow lift to gently raise and arch the brow. This is done with minimal scarring and a blepharoplasty is done at the same time.

It must also be said that it is a big mistake to do a blepharoplasty alone in a patient who really needs a brow lift because then, you will be dragging the brows further down.

In order to answer this question, one has to know if the patients eye brows are

1. brows currently droopy?
2. patient male or female?
3. where the brows always heavy or is this change new?
4. In youth, did the patient like their eye brow position?
5. Does the patient have a problem with dry eyes

In order to answer many of these questions, my patients are instructed to bring in photos of themselves from their 20's and each decade up until the age at which they present. This helps me understand the evolution of their aging eye area.

Yes, heaviness in the eye brows contributes to heaviness in the upper eyelids as it tends to push down excess brow skin over the eye lids.  

In male patients who always had heaviness in their eye brows, the most natural approach is simply an upper eye lift. This avoids an unnatural feminized appearance which can result from lifting the brows in men especially if overdone.

In female patients, if their eye brows are heavy but have not changed in position, I tend to not lift the brows if they liked where their brows were positioned in youth.   An upper eye lift alone is sufficient to rejuvenate the eyes. If there is a significant change in their brows, then I will recommend an upper eye lift and brow lift.

Caution: I will try to avoid performing a brow lift and eye lift in someone who has a problem with dry eyes as this can accentuate the problem. Patients are certainly warned.

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