Opinion on lower Blepharoplasty/ brow tack, why not a Brow Lift? (photos)

Question

I went to see a PS that only works on the eyes. He suggested I have a left brow tack to fix excess skin above left eye and a lower bilateral blepharoplasty. Do you think this is an appropriate route? Why not a brow lift? Will this fix the loose skin under my eye?

Lawrence Kass, MD · Answer

First, let me congratulate you on seeing someone I assume is an oculofacial plastic surgeon.  Since you are most concerned with the area around your eyes, this is easily the best type of doctor to see to address your concerns. That said, I personally am not a fan of the brow tack procedure for many reasons.  I prefer brow lifting,. as your post suggests.  I don't wish to make specific suggestions based on the one photo you provided.  I do suggest that you seek out another opinion from an oculofacial plastic surgeon near you with good ratings on RealSelf.  Good luck!

Roberto E. Garcia, MD, FACS · Answer

Thank you for your question.  Treating the peri-orbital area can be a challenge.  You have asymmetry and that is actually more common than you think.  It is not clear whether you have botox in the forehead, as the position and the shape of the brows look off a little.  My preference is to not take additional volume from the eyes as a sunken look to the upper eyelids can age someone.  If you look critically at your pictures, you will see a few things.  First, the medial (inside) brow looks descended below the level of the bony rim and that is something that a browlift can address.  Secondly, You want to have a gentle curve of the brows above the rim (.75-1cm) with the high point being at the level of where the colored part of your eye touches the white (lateral limbus). Last is that you do in fact have a lower eyebrow on the affected side and this needs to be addressed.  The technique is surgeon specific, but if those core issues are not addressed, it may not look natural.

One more thing, if you truly meant for me to look at your lower eyelids, then yes, you have hollowing.  You are probably thin and have noticed more hollowing around the eyes.  Look into Fat Grafting to that area.  The results are phenomenal.

Please seek the advice of a Facial Specialist who is double board certified in Facial Plastic and Reconstructive surgery.

Kenneth D. Steinsapir, MD · Answer

Your issue has nothing to do with your eyebrows.  You have upper eyelid ptosis with a dehiscence of the upper eyelid levator aponeurosis tendon.  You are lifting your eyebrow to compensate.  Doing a browpexy procedure will not help you.  It will make both eyes look hollow.  Do to the levator dehiscence, you have an inversion of the upper eyelid so you are missing a normal upper eyelid fold on the right and the fold on the left you fold is hollow but there is the appearance of a fold because the brow on the left side is not as compensated as the right (there is more elevation of the right eyebrow).  That is due to the fact that you have more ptosis on the right side.  Please don't go to eyelid surgeon who do not understand eyelids.  You need an anterior levator resection ptosis repair.  This also creates the opportunity to make a more normal upper eyelid fold and allow the eyebrow to relax to a more natural position.  I also do not think you will benefit from lower eyelid surgery.

Jeffrey Joseph, MD, FACS · Answer

Thank you for the question.  I prefer the endoscopic browlift , as it can keep the brow shape while elevating the brow as a unit to prevent lateral peaking of the brow.  After this is done and things have settled a bit, a conservative upper lid bleph may be needed.  It appears you have minimal fat pads of your lowers, but more photos are needed to completely assess.

Nathan Eberle, MD, DDS, FACS · Answer

you appear fairly young with some excess skin of your upper eyelids, left more than right. The Brow tack you are referring to is likely to be used to perform a brow lift but elevating the brow and "tacking" the skin up to it. This can work to raise the brow, will stretch out some of the loose skin, but not likely all of it. As for the lowers, it doesn't appear you have large/proptotic fat pads, so I am not sure exactly what you or he is trying to accomplish with a lower bleph. Maybe the picture is misleading, my suggestion, find another couple surgeons to have an in person consultation, maybe this so called expert of the eyes really isn't that.

Opinion on lower Blepharoplasty/ brow tack, why not a Brow Lift? (photos)

Answers (7)

Answer: Many ways to get the look you desire

Answer: Many ways to get the look you desire

Answer: Not likely

Answer: Not likely

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Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.

Opinion on lower Blepharoplasty/ brow tack, why not a Brow Lift? (photos)

Answers (7)

Answer: Many ways to get the look you desire

Answer: Many ways to get the look you desire

Answer: Not likely

Answer: Not likely

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.