Facelift and Lateral Brow or Eye Fillers First?

I had an endobrow lift over a year ago, lateral brows have fallen. My inner upper eyelid junctions are more hollowed out. From an aesthetic standpoint, does it make more sense to have the upper eyelid junctions filled in, and some type of filler placed under the lateral brow to try to raise first, or have the facelift and necklift first? The doctor who would be doing the surgery said he could also do a lateral browlift at the same time. Does filling in under lateral brows work? Surgery and fillers have to be done by two different doctors. Thanks.

Doctor Answers 17

Facelift and lateral browlift vs. fillers

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If you are contemplating surgery, it is best to undergo the surgery first rather than put in temporary fillers first. It may also be possible to add autologous (from your own tissues) fillers during surgery.

You would not want to confuse the issue by having filler in an area that otherwise might be correctable by surgery.

Hyaluronic acid fillers are fine for after surgery for small areas that were not corrected by the surgery.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Droopy lateral brows after endoscopic browlift

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Unfortunately, you are not the only patient who experienced that the brow tails (= lateral brows) went down after endo browlift.

For best aesthetic outcome, it sounds to me that you want a combination of volume restoration of the brow/ upper lid region (we usually use fat grafting for this) with a lift of the temporal brows. I have seen many patients in whom the central brows are too high and should be brought down.

If you have fillers done for the lids/brows, I would recommend the browlift first followed by the volume.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 51 reviews

Surgery or Fillers First?

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Typically, surgery first and then utilize the dermal fillers to refine the appearance. The same surgeon can generally perform the surgery and fillers.

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Timing of Facelift, Lateral Brow/Temple Lift and Fillers

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This is a tough question to answer without examining you. In general if a limited lateral brow lift (also called short scar temple lift) is performed at the time of your facelift it is possible to add filler in depressed areas that were not undermined (or else deep to the undermining surgical plane). I do this often in selected patients.

On the other hand when a more extensive temple/lasteral brow lift is required, I recommend doing the lift first then waiting at least 3-6 or more months prior to considering fillers.

Facial fillers and lifting brow

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Facial filler can temporarily lift the lateral brow a bit but can also make the lateral brow look a bit prominent.

Facial surgery or fillers first

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Fillers are not used to raise the eyebrows.  They are used to augment nasolabial folds and wrinkles around the lips.  A lateral brow lift typically does not hold if only skin is removed.  Your forehead is a very complex and dynamic area of the face with both elevator muscles and depressor muscles.  These need to be surgically softened, balanced and addressed through a formal brow lift procedure.  This is not done through an endoscopic brow lift.  A brow lift and a facelift can be done at the same time.  In addition to adjusting the corrugators, frontalis, and procerus muscles, sometimes fascia grafts can be placed in areas in the vertical two creases at the medial head of the eyebrows to augment the dermal atrophy that occurs in that area.

Fat transfer versus facelift with temoporal lift

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Lateral brow ptosis does occur sometimes after endo brow lift. I feel that fat transfer will correct a mild degree of ptosis, but if you are in need of additional facelift surgery, the I would recommend a temporal lateral brow lift be considered as a better long term solution.

Facelift vs Fillers

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I hear two different issues. while I agree with many of my colleagues on this board - surgery then fillers, I think the inner eye is a seperate problem entirely for which none of the surgeries you mention will address. If you are considering a Face/Neck plasty then certainly go ahead. The lateral brow can be revised/lifted at the same time.

Although some patients like the hollowed out upper lid so makeup is easy to apply and one gets that doe eye look, many women and plastic surgeons feel it is an over operated look. I have not added filler in this area. there is no soft tissue of sufficient substance to camoflage the filler and I would be concerned it might show. I do like periorbital micro fat grafting though as a wonderful way to add youthful 'plumpness' to that area. I generally add it to the area under the eyebrows both medially and laterally. It will extend a little down on the upper lid just below the eyebrow proper.

Fillers are a nice way to lift tissue

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Fillers are a nice way to lift tissue and often patients don’t need a facelift after they receive this treatment. This is what is known as a liquid facelift. Sculptra is not a filler but is a superb product for contouring and lifting the face without surgery. The lateral brow is an excellent place where fillers can be used to lift the brow and often eliminate the need for a surgical browlift. BOTOX can also be used in the lateral brow to lift and re-train the muscles that shape the brow.

Fillers and Facelifts

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Fillers, in general, should be done after the surgical procedure (in this case facelift plus browlift) has been completed. If done prior to surgery, the appearance of the filler may become distorted. It is best to wait several weeks after surgery, so that most of the postoperative swelling has resolved. However, if fat grafts are used to correct volume loss instead of fillers, the grafts are placed at the time of surgery, immediately after the facelift and/or browlift are finished.

Pamela B. Rosen, MD
Coral Springs Plastic Surgeon

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.