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Why Do So Many Docs Raise Eyebrows to Levels Reminiscent of 50's Holywood?

I have lateral hooding of the eyelid and have been reviewing many before and after browlift photos. It amazes me that so many results look unnaturallly high with many of them raising the medial area and creating a hollowed, closed in, and almost an eliptical eye. Are patients really really asking for this?

Doctor Answers (8)

Why Do So Many Docs Raise Eyebrows to Levels Reminiscent of 50's Hollywood?

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          I would just keep looking for a surgeon with whom you find common ground with the ideal brow aesthetic.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial procedures and brow lifts each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA


Los Angeles Plastic Surgeon
5.0 out of 5 stars 237 reviews

Why Do So Many Docs Raise Eyebrows to Levels Reminiscent of 50's Holywood?

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Not sure, the aesthetic ideal eyebrow position is well described in my book on the aesthetics of beauty.

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

High eyebrows

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You are right.

One famous cosmetic surgeon showed pictures of his brow/facelift results at one of our meetings. One surgeon in the audience asked if the speaker did not think the brows are unnaturally high? The speaker answered:"But that's what my patients want...!".

Looking at young females show their middle eyebrows low and on the side in a slightly arched position. It is sometimes difficult to convince our patients what is "normal, natural" looking and what the prospective patient envisioned to look "natural".

Have a candid conversation with your surgeon of choice. My rate of "true brow lifts" has dropped considerably in the last few years.

Guido P. Gutter MD
Evansville Plastic Surgeon
5.0 out of 5 stars 9 reviews

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upper blepharoplasty for lateral hooding

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 The decision on whether or not to perform a brow lift  will depend upon the position of the eyebrows. When patient's have lateral  hooding of the eyelids with a normal brow position, a upper blepharoplasty is recommended. If there is a low brow position, then a brow lift is recommended.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

The

+1

Thank you for your question. Although brow lifting is one of the most common procedures performed in my practice, many patients are alternatively served with neurotoxins (Botox, Dysport, & Xeomin).  If done well, a slight elevation of the lateral brow can be achieved while still softening some of the forehead wrinkles/rhytids. Limitations do exist. If you have a very heavy brow, neurotoxins alone will not do the trick. Your surgical solutions then become a direct lift or mid forehead lift (rarely the best option), coronal lift (infrequently used in my hands), and the endoscopic or combination endoscopic/pretrichial lift. The latter option, works well for properly positioning the medial and lateral brow to an ideal position, hiding the incisions, altering the hairline, and minimizing the risk of alterations to forehead and scalp sensation.  In the end, each method is just a tool and must be properly performed with a keen aesthetic sense. 

You are correct that over-elevation of the medial brow never looks good, only surprised. The ideal female brow starts with the medial head at the orbital rim and rises slightly laterally with the apex at point above the lateral edge of the iris (lateral limbus). This ideal lateral peak has varied in position as society's aesthetic has changed. That said over-elevated brows medially or laterally look abnormal, and even more abnormal on male patients. Not to be left out, over-plucking of eyebrows can have a similar effect, is not recommended, and is difficult to undo.

 As for the hollowed upper lid, this is often something that is unmasked by, but not created from a forehead lift/browlift procedure. Volume loss is something that is common with aging and the periorbital area is no exception. Injected filler and fat grafting can help in these situations. This hollowed out look is also very common after upper eyelid surgery in which over resection of periorbital fat was performed. Unfortunately, this practice may be the biggest reason for the hollowed out/oversculpted eyelids that were common through the mid 90s. 

As for where to go from here? It is best to evaluate a surgeon's before & after results to help you appreciate their aesthetic sense and make sure it matches your own. Digital imaging can give you an idea of what your results may look like and make sure that you and your surgeon are of the same mind prior to any surgical procedure. I hope this helps. Take care.

Robert Brobst, MD
Dallas Facial Plastic Surgeon

Unnatural Browlift Results

+1

You are correct when you observe that a centrally elevated brow is usually not attractive and youthful. During forehead rejuvenation, the brow should be reshaped and repositioned - but conservatively. There are regional differences that can be observed. For instance, in New England we prefer the subtle look; patient rarely ask for dramatic browlifts with the brow high up in the middle of the forehead.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 28 reviews

Brow lifts..

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You are right in that many patients want a dramatic change rather than the subtle changes that most surgeons prefer to achieve. The goal of brow lifting and any other form of facial rejuvenation surgery is to create a natural and more youthful appearance

Sheldon S. Kabaker, MD
Oakland Facial Plastic Surgeon
4.5 out of 5 stars 9 reviews

Patient expectations and brow lifting

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The natural position of the arch of the eyebrow is 10 mm above the supraorbital rim.  When performing an brow lift I demonstrate to the patient in the mirror the proposed elevation of the brow.  At that time we measure and then attempt to recreate this level surgically.  All surgery can be over done.   The trick is obtaining and natural result and meeting patient expectations.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 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.