Direct brow lift and scars? (Photo)

Question

I have a significant reduction of visual field from drooping eyelids and my eye doctor referred me to a plastic surgeon. He recommended getting a blepharoplasty and an eyebrow lift. I have a receding, thinning hairline so the surgeon wants to make the incisie above the brows The doctor wants to cut straight above the eyebrows. He only needs to lift the sides of the brow. So the scars only come to half. See picture. . Is this a good procedure likely to lift the brow and leave scarring or is their a better

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. A blepharoplasty and an eyebrow lift are often performed together because the procedures are complementary and having procedures done together will allow a smoother and quicker recovery time. The endoscopic procedure is preferred, when possible, because it has a quicker recovery time and is generally less invasive. I suggest that you move forward and consult with a board certified facial plastic surgeon.
Best wishes,

Goretti Ho Taghva, MD, FACS · Answer

Thank you for your question.  You would definitely benefit from an upper blepharoplasty for treatment of your heavy eyelids, but it certainly won't be enough.  A brow lift would be needed to help improve your brow position and lateral hooding.  Can't see your hairline in the photo, but if it is indeed receding, endoscopic option may not be ideal and you are left with 2 surgical options:  direct brow lift above the eyebrows and coronal pretrichial brow lift (meaning scar will be placed right at the hairline, but it won't pull the hairline further backwards) Pretrichial browlift most likely will give you an even better long term result.  Both will cause more visible scarring compared to the endoscopic technique, so it's  very critical that your surgeon employ techniques to minimize hair loss (at the hairline/ the brow) so ideally your hair will camouflage the scar.  Good luck!Goretti H. Taghva MD

Robert J. Troell, MD, FACS - Account Suspended · Answer

Good Day. Thank you for your question.You photographs show significant excess upper eyelid skin, especially laterally (temporally). However, your lateral brow is only mild-moderately droopy (ptotic).An upper eyelid cosmetic surgery (blepharoplasty) is obviously indicated and the technique is standard. The key to minimize the surgery is to ensure their is no dry eyes before surgery, and if there is, a more conservative removal of skin is warranted.Brow lifting in men with a higher hairline limits the best potential surgical options, which are delineated in a peer-reviewed paper:Koch RJ, Troell RJ, Goode RL: Contemporary management of the                     aging brow and forehead. Laryngoscope. 107(6): 710-715, 1997.You may be a good candidate for trying the brow lift without surgery:Some patients can even achieve a satisfactory brow lift appearance without surgery, by both a permanent filler (bellafill) placed along the superior brow hair (some patients also sneed the temporal hairline and temporal fossa filler) and minor alterations to the brow hair, especially below the highest point of the brow.
A direct brow lift offers the advantages of being the BEST suspension brow lift procedure and the most Exact, since it is the closest incision to the brow itself. The disadvantages are the incision may be noticed and the incision can feminize a patient. Most men do not desire this outcome. However, with only the lateral aspect of the incision needed, this feminization appearance is minimized.The brow lift surgery or brow lift changes with filler and hair reshaping should be done before the upper blepharoplasty (either days to weeks before or immediately before the same day). The reason for this is that once the brow position is set, the exact amount of skin removal can then be determined, without excising too much skin to avoid producing a dry eye syndrome.
The following techniques can optimize the direct brow final incision appearance: beveling (angling the knife blade during the incision) into the superior hair can hide the incision, minimizing tension on the incision during closure assists in keeping the incision thin, excellent fine plastic closure, and skin resurfacing early with a CO2 laser or radio frequency (RF) about 8 weeks post-operatively. Many surgeons prefer the endoscopic approach, however, the advantage of this technique is the hidden incisions in the hairline, but the disadvantage is less ability to lift the brow and not as accurate or consistent results. 
In summary, the limited direct brow lift is an excellent alternative to the endoscopic brow lift, however, with the upper blepharoplasty, bellafill injection to the superior aspect of the brow hair and minor brow hair changes you may get away with out brow lift surgery. 
I hope you have an excellent result and a pleasant aesthetic experience.

Direct brow lift and scars? (Photo)

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Direct brow lift and scars? (Photo)

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