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Eyebrowlift & Upper Eyelid Which Method?

I want my upper eyelid more noticable & my eyebrows are too droopy. But find a complete forehead lift (both methods) too drastic. Although I'm getting a co2 fractional laser treatment (2-3 treatments) I dont want noticable browscares. I do have 2 deep forehead wrinkels, but dont want injecables.Prefer 1 totall solution for this all. What are my options? Which treatment would be wise?

Doctor Answers (13)

Eyebrowlift & Upper Eyelid Which Method?

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For what you are describing it sounds like you would benefit from upper eyelid blepharoplasty.  That is the most effectictive method to achieve a crisp upper eyelid.  As far as the droopy eyebrows, you could also try Botox to lift them up a bit but would not give you the same results as a surgical lift, without a photo it's difficult to determine which procedure would be best for you. 


San Diego Plastic Surgeon
4.5 out of 5 stars 7 reviews

Eyebrow vs. upper eyelid lift

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Posting pictures would be helpful but short of that you can follow the link below to see whether you need a brow lift or an upper eyelid lift.  Good luck.

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 138 reviews

Browlift

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If there is a facial rejuvenation surgery that is over-recommended and often overdone these days, it is without question the browlift. Look no further than the celebrity photo magazines for pictures of stars who look like they have just sat down on a plate of tacks. The goal of aesthetic plastic surgery should be to make a person look better and more youthful, not merely different, and certainly not as though one is perpetually surprised. My goal is to provide my patients with results which appear natural, and an unnatural-appearing brow is a dead giveaway that a person has had facial plastic surgery.

I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead – if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious.

A youthful, feminine brow rests above the level of the orbital rim, which is the upper margin of the bony socket in which the eye resides. An aesthetically pleasing brow is somewhat arched laterally, and the lateral end or "tail" of the brow is higher than the medial end. It is quite common for the female brow to assume an essentially flat or horizontal orientation as a person ages.

If the skin and soft tissues lose enough elasticity with age and sun exposure, the lateral brow may even descend to a level below the orbital rim, producing a tired or even 'surly' appearance. The medial brow is relatively fixed in position and in most cases does not descend much, if any. In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.

While I used endoscopic browlift techniques for several years to treat brow descent, more recently I have transitioned to performing a limited incision lateral browlift that does not require the use of an endoscope. The relatively short incision is hidden behind the temporal hairline, and no incisions are required in the scalp directly above the eyes. The advantage is as follows: this approach allows me to not only redrape the lateral brow (conservatively!) in a higher position, but it also allows me to reposition the skin and soft tissues of the lateral periorbital area in an upward direction, producing a more complete rejuvenation of the periorbital area. Additionally, through this same incision I can perform suspension of the midface (cheek) if that is part of the surgical plan.

Rejuvenation of the brow by means of a lateral browlift will also, in most cases, improve the appearance of the upper eyelids. When the lateral brow is repositioned above the orbital rim, the vertical elevation may eliminate the appearance of wrinkled or 'crepey' upper eyelid skin. If the lateral upper lid skin is 'hooded' over the lateral corner of the eye, this improves as well. While upper blepharoplasty (upper lid skin excision) is often performed in concert with a lateral browlift, for many patients the upward positioning of the brow eliminates the need for skin excision.

The frown muscles (aptly named the 'corrugator' muscles) which create vertical frown lines between the eyebrows can be removed at the time of a browlift. This can be done endoscopically, through small incisions behind the hairline directly above the frown lines, or through an upper lid incision if upper blepharoplasty is being performed. Many patients undergoing this procedure have enjoyed the effect of BOTOX injection in this area and desire a permanent correction of vertical frown lines. In some cases I perform corrugator muscle removal alone for patients that do not have (or are not troubled by) descended brows.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 40 reviews

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Forehead Rejuvenation Options

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Surgical and non surgical options exist to rejuvenate an aging forehead. Laser resurfacing and chemical peels can be used to address the mild to moderate wrinkling of the skin. Botox or Dysport can also soften the wrinkles across the forehead and between the brows. However, if the wrinkles are a result of using your forehead (frontalis muscle) to lift your brows because of either low brows and/or excess skin on the upper eyelid, then a surgical option is required. There are several surgical techniques to lift the forehead/brows. The endoscopic brow lift is a less invasive technique that offers natural results. An upper lid blepharoplasty will remove excess skin and soft tissue on the upper eyelids. The best option for forehead rejuvenation may be a combination of surgical and non surgical modalities. This can only be decided after a thorough exam and a discussion of risks,  benefits and desired goals.

Cynthia Gregg, MD
Raleigh-Durham Facial Plastic Surgeon

Eyelid Rejuvenation and Brow Lift

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With drooping brows the most common technique used today is the endoscopic brow lift.  I use 5 short incisions that are beyond the hairline and are therefore hidden.  Good results can be achieved without the ear to ear incision of the open brow lift.  During your preoperative evaluation it would be determined if a brow lift alone is enough to rejuvenate your eyes or upper eyelid surgery is needed as well.  If an upper lid blepharoplasty is needed the scar will end up in the crease and is essentially imperceptible.  Be sure to see a board certified plastic surgeon for your evaluation.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
5.0 out of 5 stars 17 reviews

Forehead lift and upper blepharoplasty

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Forehead lifts can often be done endoscopically through 3-5 very small scalp incisions that are usually well hidden. This will also correct lateral brow hooding.  An upper lid blepharoplasty can be combined with this to "OPEN" your eyes a bit.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Brow vs. Upper Eyelid Lift

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The limited lateral browlift is a nice technique for elevating the eyebrows in a mild fashion to create likely the look you seek.  With this procedure, the incision can be largely concealed within the hairline.  An upper lid blepharoplasty may be helpful as well to further open the eyes.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
5.0 out of 5 stars 45 reviews

Eyelid or eyebrow surgery

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  Certainly, it is impossible to say without seeing photos of you.  I usually say that my small incision forehead lifts include upper lid surgery, but the reverse is not true.  Certainly, upper lid surgery alone will not help the wrinkles in your forehead.  Some doctors will try to alleviate certain lines in the forehead during an upper lid bleph through the same incision but it is not an integral part of the procedure.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.5 out of 5 stars 39 reviews

What's best brow lift or upper eyelid?

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Without a photo there's no way to make an insightful observation.  In general this is how a plsatic and cosmetic surgeon or an occuloplastic surgeon would evaluate the fullness in the upper eyelids to decide which is the proper surgical procedure.

IMHO, it's imperative that the eyebrow position be determined, compared to the aesthetic ideal, as part of any upper eyelid/brow lift surgery. 

To do this, the plastic and cosmetic surgeon or occuloplastic surgeon stands behind you and using their hand, elevates one eyebrow to the aesthetic ideal position.  Once this is done three possible outcome dictate the proper way to deal with the upper eyelid fullness.
1. All the upper eyelid fullness is gone with the eyebrow in the aesthetic position.  This indicates the brows are low and all the upper eyelid fullness is related to the low eyebrow.  A brow lift is the only proper surgical remedy in this scenario and should the surgeon perform an upper eyelid surgery (blepharoplasty), the eyebrows will be pulled down into an even lower position with the skin closure.
2. Some of the upper eyelid fullness is gone but some also remains.  This indicates the fullness is partly due to a low eyebrow and partly due to excess upper eyelid skin.  That amount due to upper eyelid skin can be removed with an upper eyelid surgery, that due to low brow removed with a brow lift or a combination of both to remove it all.
3. The upper eyelid fullness does not change indicating all the fullness is due to upper eyelid skin.  In this scenario and upper eyelid surgery is the procedure of choice.

If it is determined that a Brow Lift is required, than that is the proper aesthetic thing to do.  If you are not willing to have the surgery or the scars, then do nothing but it's aesthetically unwise...always, IMHO, to do the wrong thing.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Forehead lift and blepharoplasty

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It sounds like you probably need a combination of eyelid surgery (blepharoplasty) and brow lift. Brow lift is most commonly done endoscopically nowadays (unless there is a reason not to) so there is no noticeable scars with this approach. The scar from upper eyelid surgery is usually not noticeable as well. During the brow lift procedure it is also possible to weaken the frontal is muscle which creates your forehead wrinkle thus solving two problem with one surgery. Having said that, surgical weakening of the frontalis muscle mostly fell out of favor with the advent of Botox which, although being much shorter lasting modality, is a safer procedure. You may also be a candidate for midforehead lift approach since you have prominent forehead wrinkles --with this approach the incision is placed in the wrinkle itself; it is not as commonly used as endoscopic brow lift but has its own advantages (does not raise the hairline). In summary, what you need is a consultation with an experienced surgeon who could recommend procedure(s) based on your specific situation.

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 11 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.