Will an upper blepharoplasty exaggerate hollow brows? (photo)

Question

My eyebrows have some slight hollow/depressions in them, and I have an upper bleph scheduled, which I dont think is going to impact that area, but I am concerned that it will exaggerate the issue or create more hollow appearance.

Gianfranco Frojo, MD · Answer

You have levator ptosis. You would benefit from a ptosis repair at the same time of the upper eyelid skin removal surgery.

Joel E. Kopelman, MD, FACS · Answer

Thank you for the question. An upper blepharoplasty works on the skin and sometimes a small amount of fat in the lid itself, below the brow, so it does not directly change the bony or soft tissue hollow in the brow area above. Your concern is a good one though, because the two areas are connected visually. When excess lid skin is removed and the eye looks more open, the brow region can appear a bit more defined, and a hollow just above the lid can become more noticeable. This is most likely when too much upper lid fat is removed, since that fat helps fill the transition between the lid and the brow. The best way to avoid this is to be conservative with fat removal and preserve volume, and in some patients with a hollow upper lid I place fat or a small amount of filler at the time of surgery, or leave the fat pads alone entirely. Mention the brow hollow to your surgeon before the procedure so the plan can be adjusted, and ask them to show you on your photos what they will and will not remove.

Edward Buckingham, MD · Answer

Hi there. Yes, it can potentially make the hollowing more prominent if your surgeon performs fat removal with your upper bleph. Not every upper bleph involves fat removal, so this is something you should discuss with your surgeon.

David Hill, MD · Answer

It can, if the upper lid is already hollow and the surgeon removes fat or too much skin. That's a fair worry, and it's why the plan counts for more than the procedure name.
If your upper lid looks hollow, a surgeon should take only skin, leave the fat alone, and in some cases add volume to the brow and upper lid with fat grafting or filler. Taking out fat in an already hollow lid makes the eye look older and more sunken.
Also check the brow. When the brow has dropped, it pushes skin onto the lid and looks like excess eyelid skin. Removing lid skin in that case can pull the brow lower.
Bring this exact question to your consultation and ask the surgeon to show you, in a mirror, what they plan to remove and what they plan to leave.

Lexie Wang, MD · Answer

to answer your question -- yes, an upper bleph will almost certainly make your eyelids look hollower, esp if they plan to be aggressive and do any kind of fat manipulation.

Kenneth D. Steinsapir, MD · Answer

Your upper eyelid issue is central levator disinsertion ptosis and a compensatory eyebrow elevation. You will not be helped with an over aggressive upper blepharoplasty. Less is more. I also suspect that you would benefit from having the lateral canthal angles reinforced with canthoplasty. If you just have upper blepharoplasty, this is a skin, fat, and muscle removal surgery. It has a significant risk of making the upper eyelid look too hollow. My approach  is to repair the upper eyelid ptosis, lower the upper eyelid crease, and restore volume to the upper eyelid fold.  There is no substitute for a detailed, in person assessment.

Gary M. Horndeski, MD · Answer

The blepharoplasty will not exaggerate the eyebrow hollows but you do need a brow lift more than a blepharoplasty. Your medial eyebrows are below the level of the orbital rim and they should be at or above the level of the orbital rim. A brow lift done at the hairline will lower your hairline, remove the wrinkles in the forehead and elevate the eyebrows to the appropriate position. I strongly suggest you undergo a brow lift instead of the blepharoplasty.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

Removing a skin fold from upper eyelids would further exaggerate hollowness, very likely. Additionally of skin grafting to augment lower aspect of upper orbital rim may help. Good luck.

Michael McCracken, MD · Answer

I think a blepharoplasty is the wrong procedure for you.  You have ptosis (weakness of the eyelid lifting muscles) and would benefit from a ptosis repair.  A ptosis repair would open up your eyes and may even slightly help with some of the hollowness you see.  You need to consult an oculoplastic surgeon who is a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).  You can find one on the website ASOPRS dot org.

Will an upper blepharoplasty exaggerate hollow brows? (photo)

Answers (9)

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