I went to two different doctors to discuss my angry looking appearance. One suggested an endoscopic brow lift and the other suggested traditional eyelid surgery. Doc 1 believes I have low eyebrows so a lift would tackle the heaviness in my lids as well. Doc 2, believes that since I am still young, the heaviness in my lids will eventually return so the surgery on the upper and lower lids would suffice. I researched laser surgery is best for fat, not excess skin and Im not sure what I have.
Brow Lift or Laser/Traditional Blepharoplasty?
Doctor Answers 19
Browlift not necessary in person with good brow position
I do not think you need a browlift. I understand what you are saying about angry look and you are looking for solutions. The brows look to be in good position and I agree with previous comments that many people have brows that are too high after surgery. In my opinion you certainly do not need brow elevation. I cannot tell from photo but it looks like you might be frowning and a neurotoxin like Botox or Dysport could help. Also, after examining you, your plastic surgeon should be able to tell if having Botox/Dsyport to manipulate the brow level could also help. You need physical exam for more definitive answer. From the picture it almost looks like your medial (part closest to your nose) is a little too high. It that is the case, Botox/Dysport could lower it. The strong advantage of Botox/Dysport in a case like yours is that it wears off-so if you don't like the new brow position, it is only temporary. The other thing that might be bothering you-the lower lids have a very prominent roll; this is part of the lower eyelid muscle. It may be contributing to making you look like you are squinting/glaring. It is possible to soften the appearance of this muscle, to flatten it a little bit. This might help but has to be done very judiously. Seek out the most experienced eyelid surgeon in your areal; this person will also be very experienced in the nuanced uses of Botox/Dysport. If you are Asian, I am not sure if you are or not, seek out someone who specializes in Asian eyelid surgery. Hope this helps.
Tracy M. Pfeifer, MD, MS
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I would not recommend suegery
You have very beautiful eyes and i would wait. Your picture is taken outdoor and there over activity of the frowning muscle. You may try Botox and wait on surgery. Botox is temporary and if you did not like the results,you can have surgery later.
Subtle upper blepharoplasty works well.
1) Judging by your picture, your eyebrows are already on the high side. You should absolutely avoid a brow lift. (Again, assuming that detailed physical examination confirms the impression I get from your photograph.)
2) You should not have lower blepharoplasty of any kind. I think laser surgery for the eyelids is largely a gimmick and I would recommend avoiding that.
3) If I understand what actually bothers you about the appearance of your eyes, then a subtle upper blepharoplasty would correct the heaviness of your upper eyelids (specially in their outer part), and make you look less "angry".
4) But you look young and attractive. So proceed with caution. It would not be hard in the wrong hands to leave you looking worse.
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Less is more.
Lets keep this simple: You are young and your anatomy is appropriate for your age. Browlift, in my opinion, is out of the question for you. It will leave you with an unnaturally elevated brow. Your eyelids are a bit heavy, and I'm inclined to think that this is your normal anatomy, rather than aging.
If you are not pleased with this heaviness, a very subtle skin excision [laser for skin removal is more of a gimmick than anything else] would expose a bit more of your eyelid platform, making makeup application a bit easier perhaps.
Best of luck
Surgery for you will be a big mistake.
It is critical to ask the right questions. The question is not should my surgeon use a laser or a scalpel, or should I get a forehead lift or an upper eyelid surgery. The right question is aesthetically, my upper eyelid space is crowded and my eyebrows look heavy, what are my options? There is no substitute for a personal consultation. So let me discuss this generally. In looking at your photos, I notice a pinch along the eyebrow and also the upper eyelid folds rest into the upper eyelid platform which reduces their ability to hold makeup. First you should know that the laser for eyelid surgery is most fun for the surgeon and marketing hype for the patient. The laser does not make a better surgery. The most critical aspect of the eyelid surgery is the design, where to place the incisions, how to structure the eyelid crease and how much upper eyelid fold should be left. Complicating this is the reality that the eyebrow will relax as skin is removed from the upper eyelid fold. Over aggressive upper eyelid surgery will deprive you of one of the most important characteristics of your youthful face, which is a full upper eyelid fold. If you have upper eyelid surgery, it needs to be an extremely limited procedure to show a uniform strip of upper eyelid platform across with width of the eyelids. A personal consultation is needed to determine your preference for how much platform shows under the fold. Almost no fat and muscle should be removed from your eyelid. Is an endoscopic forehead lift an alternative procedure. The answer is a properly performed endoscopic forehead lift is an alternative. However, I believe that it is unnecessary at this time.
In fact, I believe that all you need to make a profound difference at this time, is microdroplet BOTOX for the eyebrow and a small amount of filler for the lower eyelid hollow. Please do not be in a hurry, that is how mistakes are made and start with the things that wear off. Stay safe out there.
Brow lift or lid surgery for younger patients
Given your young age and photo, your brow looks quite normal. Even the lid is full but fairly youthful. Look over the hundreds of fashion magazines and you will find that your picture as best I can tell is normal and attractive. And surgery on your lower lids, really? Both surgery recommendations seem like too much too soon, and perhaps just a little Botox will relax your features and reduce the frown. My vote is a search for doctor number 3.
Best of luck,
Browlift or blepharoplasty
Your brows are fine where they are. Some surgeons overdo the brow-forehead lift. You mainly need upper lid blepharoplasty which is a much smaller surgery and will most likely satisfy you. It really does not matter how the skin-muscle-fat is removed whether it is with a laser or with more traditional means.
Brow Lift or Blepharoplasty - Consider Computer Imaging
Mimi, you are young, and have beautiful eyes. As a surgeon I would be reluctant to do anything to significantly change the shape of your brows. While you may feel your eyes look "angry," the shape and height of your brows are elegant. I would personally be more inclined to address the heaviness in the upper lids - with subtlety - rather than elevate the brows, but you are one of the patients who I think might benefit from computer imaging. Using the imaging tool we can simulate our projection of what each procedure would achieve, and especially for brow lift patients this can be extremely useful in deciding whether or not to have the procedure. You may want to ask the surgeons you visited if this option is available.
Brow lift vs. blepharoplasty
Your photos show that the lateral 1/3 of your brow is higher than the medial 2/3. This is the aesthetic ideal. You also have good "show" of the upper lateral eye-socket bone. Also a goal in the aesthetic ideal. However, your soft tissues (upper lid skin, upper lid fat) give you a fullness that obliterates the ideal upper lid crescent, which you don't exhibit. An upper lid blepharoplasty with removal of some skin and fat will better outline your upper lids and make you "brighter". A brow lift may leave you with a "surprise" look. Your lower lids may not require any surgery, or at most, skin/muscle tightening because you don't exhibit excess fat or fullness in the lower lids.
Blepharoplasty, Botox, and Fillers - avoid brow lifting
Mimi, your brows are ideally situated. A brow lift would give you a permanent "surprised look," so my recommendation is to avoid this procedure.
There is, however, slight heaviness of the upper eyelid skin, which you can consider removing with a traditional conservative blepharoplasty. Also consider Botox to the forehead and fillers for lower eyelid hollows to round-out peri-orbital contour.
Lastly, looking at your photo, you may also have upper eyelid "ptosis". Better quality photos and consultation would help determine if ptosis repair would be of benefit in your situation.
Grigoriy Mashkevich, MD
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