What’s next? Would a brow lift help, or a small amount of filler in my upper hollow? (Photos)

Question

Hello. I had upper bleph and lower bleph with transposition in August of 23. I had upper revision in Feb of 24 to remove a fat pad and take off additional skin. My main goal was to get rid of the a frame appearance on uppers. My lowers are fine for me. Would a brow lift help, or a small amount of filler in my upper hollow? I feel like I look sad when I’m not. Thank you.

Kenneth D. Steinsapir, MD · Answer

You have Post-upper blepharoplasty syndrome (PUBS) and also post-lower eyelid retraction. The lower eyelid issue is subtle. However you do have a lateral canthal disinsertion that contributes to a rounding of your eyes rather than an almond shape. A small amount of upper eyelid fold filler could be helpful but this is a fussy service and very few do this well. If it is done, it should be done with a relatively runny filler in my opinion. A forehead lift will exacerbate the upper eyelid hollowness. I am attaching a reference about PUBS. There is no substitute for a detailed in person consultation. A Zoom call is not the same.

Tanya T. Khan, MD · Answer

Hello, you do appear to have hollowing in the superior sulcus region (under your brow bone above your upper eyelid) - this may have become hollower after the surgery in which you had fat excised. You would benefit likely from addition of volume to this space. We usually perform HA filler injection to this region very carefully and methodically with excellent results. Please see an experienced oculofacial plastic surgeon for best results with this procedure.

Gary M. Horndeski, MD · Answer

Your eyebrows are below the level of the orbital rim and they need to be at or above the level. You would benefit from a brow lift. You may benefit from a frontal incision which will lower your hairline. You do have excess upper eyelid skin even though you have an upper blepharoplasty and revision.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Thomas Spalla, MD · Answer

A browlift may accentuate some of the upper hollowing by pulling the soft tissues superiorly.
However, a browlift can open the eyes, leading to a "brighter" or more "awake" appearance.
If you like the look achieved when your brow is pulled upwards, this may be a good solution for you.
If that doesn't achieve what you are looking for, or if you don't like that look, then I would dissuade you from that procedure.

Filler or fat grafting to the brow and along the orbital rim can help rejuvenate this region and correct hollowing.

You may desire both for an overall correction.
One doesn't obviate or necessitate the other, so you can go stepwise with this.

What’s next? Would a brow lift help, or a small amount of filler in my upper hollow? (Photos)

Answers (4)

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