Is a brow lift (forehead lift) better to raise sagging eyelids than a blepharoplasty?
The tear trough area is the region under the eyes that can appear hollow and look like "bags or dark circles" under the eyes. A filler such as Juvederm or Restylane can be helpful at temporarily fillling in the depression and restoring a youthful look to the area, this can be done in the office. Botox weakens muscles, and has no role in the treatment of the tear trough area.
Browlifts and upper eyelid blepharoplasties do different things. It is a mistake to try to do a really big browlift to make the upper eyelids look good, or a really big upper eyelid surgery when the brows have become heavier.
It is usually better to have each procedure performed conservatively, and avoid an exaggerated look or an upper eyelid that appears still heavy once the brows come down again, which they almost always do due to the powerful closing muscles of the eye acting over time. When the upper eyelids are performed with a fat conserving technique, the upper eyelids can look natural, youthful and unoperated.
You can try this yourself in the mirror and raise up the brows until the upper eyelids look good. Usually you will see a very exaggerated appearing brow contour before the upper eyelids look good. Therefore, the browlift is not the answer for both the upper eyelids and the brow, since they are really two different areas.
The main focus for browlifts in our practice is the lateral brow, the outer portion of the brow, affecting skin that lies outside of where an upper lid blepharoplasty reaches. We do not routinely raise the central brow much because this can give a startled appearance.
The types of browlift- endo vs. coronal vs. pretrichial vs. minimally invasive lateral vs. Endotine will have profoundly different effects on the appearance and the hairline. Basically, any brow procedure that originates above the hairline will raise the hairline. It is best to have a candid discussion with a number of board certified surgeons before choosing your procedure.
The effects on creating areas of baldness or loss of sensation also need to be considered. For most of our patients conderned with not having a raised high forehead when their procedure is done, we perform lateral browlifts, minimally invasive. This technique actually restores an aging hairline by lowering it slightly. It also preserves the all important deep branch of the supraorbital nerve, the branch that is cut during a coronal lift that gives sensation to the top of the head. Endotine techniques are promising but many patients complain of pain or sensitivity with the hooks underneath the brows.
For a complete discussion of browlift techniques, you may want to preview my chapter in the "Mathes" Plastic Surgery textbook on my website "drbrent.com" under Articles.
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