I've seen 3 PS's 2 say I need upper lids done and 1 says I need a coronal brow lift when I get my facelift. Please help me decide. Thanks in advance
Eyelid, brow lift or both? (photo)
Doctor Answers (9)
Upper Blepharoplasty Not Coronal Brow Lift Best Option
Thank you for your question. A bilateral upper blepharoplasty eyelid surgery will give you the most dramatic improvement postoperatively.
I understand why the plastic surgeon recommended a coronal brow lift primarily because of the deep frown lines. However a coronal brow lift leaves a very significant scar across the hairline and the best coronal brow lift will not adequately lift the brows enough to remove the hooding from your upper eyelids.
The hooding of your upper eyelids is the most dramatic visible aging change in your face and his upper blepharoplasty should open your eyes and significantly rejuvenate your appearance.
I would add that simple injection of Botox into the frown lines in the crows feet will produce 6 mm of brow elevation and lessen the deep frown lines.
Eyelift, Browlift, or Both
The position of your eyebrows does affect the sagging of loose, stretchy skin on your upper lids. Significant sagging brows will cause the eyelid fold to hang lower over your eyes. And lifting the brows even without doing anything to the lids will lift up the overhanging eyelid skin fold somewhat. From your photo, it is obvious that your eyelid skin fold hangs very low down to your lashes. However, just from the photo I can't say if your brows are loose and sagging. They may have always been in their present position and the brow skin might not be that loose. You definitely could benefit from an upper eyelid lift, but the decision regarding a brow lift would depend on an examination to determine how loose and moveable your brows really are. If they can be moved upward and you see a noticeable change, then the brow lift would probably be helpful. If your brows don't move up much with the examiner's fingers or you don't like the look of the brows positioned higher, then just leave the brows alone and accept that the degree of opening up of your upper lids from an eyelid lift might be a little less than could be achieved with both surgeries combined. Have a thorough exam by a doctor you feel confident with and consider his/her advice.
upper blepharoplasty versus browlift
The goal of an upper blepharoplasty is to remove excess skin which is hooded since it is resting on your eyelashes. There is significant dermatochalasis of the upper lids which will require an upper blepharoplasty. The decision to perform a brow lift is multifactorial and is based upon the height of the brows. The brow position is acceptable in the photo shown. If the corrugator and procerus wrinkle lines between the eyebrows( dermal atrophy) are of concern, then Botox or a brow lift can be entertained. A brow lift can be performed endoscopically, or coronal approach at the hairline or behind the hairline. Proper suture techniques of the incision will make the in scar minimally detectable in which ever technique is performed
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How to decide if I need a Brow Lift or Eyelid Lift.
Your eyebrows are quite high and lifting them will make it unnatural. If you compare your photograph when you were in your 20s you will notice that your eyebrow was much lower than what it is now. You will benefit from upper eyelid lift. If your 'frown' area is of concern, some botox and fillers can help or your PS can resect the 'frown' muscle through the upper eyelid cut and inject some fat in the area.
Browlift will help with the upper eyelid surgery
In your photo, you have a fair amount of redundant skin of the upper lids which will be improved with an upper eyelid blepharoplasty. The outer temporal portion of your brow looks to be in a pretty good position - although this is usually will the brow will fall first. However, the medial portion of your brow, between the eyes if low and heavy. If this bothers you then you will need to have some sort of browlift. While coronal lifts are occasionally performed, I do an endoscopic lift which will minimize the scars, hairloss and numbness of the head. The browlift should also help with the deep frown lines (the 11s) between the brows.
Eye Lift,Brow Lift or both?
Based on your photos I think an upper blepharoplasty (eye lift) would be appropriate as well as Botox for your vertical "11" lines and crow's feet. I do not think a coronal brow lift is indicated in your case and I rarely ever do that procedure since endoscopic brow lift is available and effective.
Eyelid,brow lift or both?
For better or worse, you have learned the one (minor) drawback for consulting with several doctors before your cosmetic procedure, namely that you may get differing opinions. Unlike another who replied, I do not think that doctors who perform coronal brow lifts are dinosaurs, although personally I prefer a small incision brow lift to the coronal procedure. Personally, I would recommend either upper lid surgery alone or combined with this type of brow lift, depending on your wishes and what is bothering you most. I would recommend consulting with someone near you who is listed in the directory or asoprs.org. Good luck.
Do not have a coronal forehead lift. Only dinosaurs perform this anymore.
The coronal forehead lift is a scary surgery appropriate for Halloween. We used to call it the "Beverly Hills hair cut." It is a nasty surgery that takes a very long time to heal from and leaves you with hair loss and no sensation on top of your head. Just from your photos, you look like you would do well with a combination of an endoscopic forehead lift (small incision with no sensation loss or hair loss) and an appropriate blepharoplasty. Perhaps you should consider seeing some aesthetic oriented oculoplastic surgeons (look on the American Society for Ophthalmic Plastic and Reconstructive Surgeon website ASOPRS dot org for their directory). In Florida you have a lot of very good options.
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.