Mid 40s but look 60. Please provide guidance on procedures. I'm extremely thin & face is emaciated. Eye lids/ brows appear asymmetrical & its unclear to me whether they require 2 different procedures. The left eyebrow appears to have drooped. Right eye has extra skin near my nose. Under eyes - hallowed with wrinkles. Despite what the pics show - my eyes do not look in two different directions. Money is not an issue but I’d like to avoid synthetic fillers & seek a more permanent solution. Thank you!
Complex Blepharoplasty, Pinch, or Eyebrow Lift? (photo)
Doctor Answers 12
Heather, Based solely on your photos it appears to me that you have lateral hooding of the upper lid, hollow appearance to the lower lid and fine wrinkling associated with sun damaged skin. In my experience the majority of patients that complain of a tired look to their upper lids it is due to inferior to medial migration of the brow into the upper eyelid area. In these patients an endoscopic browlift gives the best result. Over the years I have developed a sequential approach to browlift surgery and will, in general, do one of three different lifts depending on the preoperative anatomy of the forehead. A lateral brow lift is done for patients with heaviness of the lateral brow but a normal medial brow. A 3/4 brow lift is done for patients with a heavy lateral brow and a pinched look to the medial head of the brow. A full brow lift is performed for patients who have a heavy lateral brow, pinching of the medial head of the brow and inferior migration of the medial head of the brow. This approach yields a natural appearance to the post operative patient without that surprised look. Based on your photos I'd recommend a lateral brow lift.
The hollow appearance of your lower lid would be addressed in my office with a "SOOF lift blepharoplasty". Repositioning the SOOF fat to the depression below the lower lid works much better than other approaches in my opinion. This is because the SOOF fat used to be right underneath the lower lid and with time migrates lower in the face so by lifting this fat we are simply putting the anatomy of the lower lid back to its youthful position. As the originator of the "SOOF lift blepharoplasty" I have been doing nothing but this approach for over 15 years with excellent results. I normally use a transconjunctival approach but a subciliary approach can also be used if the patient has excessive redundancy of lower lid skin and/or muscle (which you don't, a significant minority of patients do).
For your skin a CO2 resurfacing of your skin will help the fine lines and wrinkles. For the wrinkles you see when you smile you would have to consider Botox. Hope this helps and good luck!
Complex Blepharoplasty, Pinch, or Eyebrow Lift?
Upper blepharoplasty with skin removal on the one side with a brow lift on the other may make the most sense. An exam would be necessary to confirm. Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries 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
Correction of aging of the eyelid area
Your eyebrow position is flat with no arch. There is asymmetry of the upper lids and loose skin of the lower lids with some degree of fat herniation. You would be a good candidate for an upper eyelid blepharoplasty with corragator muscle release, this will help to raise the medial portion of your brow. Also an internal browpexy can be done via the upper lid incision to reposition the brow up about 3 - 5 mm. For the lower lids you would be a candidate for a lower lid blepharoplasty with fat repositioning and elevation of the malar fat pat.
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Brow lift with or with out eyelid surgery would be best choice for you.
Your photos make you look a bit tired and sad. That is because your medial brow is down in your eye socket. A brow lift with resection of your corrector muscles on the bridge of your nose and the muscles in your medial brow, would allow your medial eye brows to rise up to their original normal position. This will remove the sad tired look. It is hard to tell how much redundant skin you have in your upper lids with out a close personal evaluation. When your brow is lifted there may or may not be skin and fat that could and should be removed from your upper eye lid. As to your lower eye lid there appears to be a bit of protruding which is causing some shadows on your cheek. This can easily remove with a trans conjunctival blephroplasty. I would recommend that you consult a Board Certified Plastic Surgeon for a full evaluation.
Brow and Eyelid Concerns
Given the upper right eyelid ptosis (droopiness) of the lid, combined with deep set orbits, you are correct in being cautious. The deep set orbits is part of your anatomy and cannot be changed easily or reliably. Any upper lid procedure would need to be combined with a ptosis repair. The brow asymmetry could be addressed with either a trichophytic or endoscopic brow lift procedure. I would favor the trichophytic approach if your hairline is high, allowing for stabilization as opposed to elevation of this feature. The best thing to do is to have a consultation to refine what procedures, if any would address your concerns.
Irregular Trichophytic Forehead LIft to raise brows.
Your tired appearance would best be improved with a Irregular Trichophytic Forehead Lift which we developed 35 years ago. The sad appearance of your eyes will not be changed with an upper lid blepharoplasty though the skin will be gone. Your lower eyelids can be improved with fat removal and repositioning thru a standard blepharoplasty.
Improving Complex Eyelid/Brow Appearance
Your condition has multiple anatomical causes, some of which affect others. Therefore, you would benefit from a combination of treatments. I would first elevate your brows into a more aesthetic position/shape via a brow lift. This should also reduce and smooth some of the "extra skin" you notice on your upper eyelid. If loose skin remains, then an upper eyelid blepharoplasty can always be done. To correct the hollowness of your lower lids, volume can be added with your own fat, although most surgeons prefer fillers. Any loose skin can be trimmed with a conservative blepharoplasty or, if the skin is just slightly wrinkled, then a TCA peel or light laser treatment might suffice to smooth out the texture.
Blepharoplasty versus eyebrow lift
The primary goal of upper lid surgery is to remove extra skin and a little fat. The primary goal on lower lids is to remove excess lower lid wrinkles and herniated fat pads. Occasionally on upper lids when there is hollowness, fat grafting can be placed to make the eyelids look more symmetrical. A brow lift is only performed when the eyebrows are low and patient's desire rejuvenation of the forhead.
Replace the Volume!
Your deep set eyes need to ahve the groove between the brow and the upper lid filled and may not need much more than a 35%TCA peel after that. Botox will improve brow position and arch. DO NOT HAVE ANY ONE RELEASE THE CORRUGATORS! This will invariably elevate your medial brows and give you a questioning look. Fillers like Juvederm or fat are appropriate. A small upper lid skin pinch may be indicated.
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.