Deep set eyes. Should I get an upper eyelid surgery, or temporal brow lift? (photo)
Doctor Answers 9
Blepharoplasty alone is a big mistake.
Your brows do not appear low. I do advise upper eyelid surgery, and volume correction for your cheeks and nasolabial folds
Thank you for your question. You submitted a photo and state you have deep set eyes. You ask if you should you get an upper eyelid blepharoplasty or temporal brow lift to address this problem. You also ask if the temporal brow lift lifts the cheeks and improves the nasolabial fold.
I can share with you my overall approach to patients like yourself who come to our practice, and how I guide my patients to what I would recommend. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. Helping people improve the appearance of their eyes, cheek area, and their face are significant parts of my regular practice every day.
When you ask a question like this, if you go to 5 doctors, or 10 doctors, you will get a different set of opinions from each one, which can be overwhelming. What I try to understand from my patient is what kind of outcome are they looking for. Generally speaking, people want to look fresh, look good, and look natural. In the modern world where so many people have an exaggerated appearance from what many consider too much plastic surgery, there is no shortage of examples where people say to me, “I don’t want to look like so and so, I don’t want to look like so and so”.
Looking at your overall appearance, when I look at your brows, my initial impression is your brows are not too low, so I would caution you about a brow lifting procedure. A brow lifting procedure, whether endoscopic brow lift or a temporal brow lift, you are trying to get at least the tail of the brow up at a certain level. When you look at your photos, I suspect the tail of the brow may be slightly lower than in the past, but I suspect it’s more likely a volume issue. There might be some value in doing something less invasive such as adding filler to the temporal area, as well as a Botox® brow lift where there are injections of Botox® done to slightly elevate the brow. The downside of that is there is maintenance involved, but I think that since the beginning of my career more than 20 years ago, I’ve always felt that if you really want to make someone look plastic, do an aggressive brow lift on someone whose brows are not that low. I have to say a lot of my colleagues really feel strongly about doing brow lifts, so it really has to be a match between the doctor’s aesthetics and patients’ aesthetics.
I suggest you also think about whether or not you are dealing with sagging versus volume loss in the cheek area and nasolabial fold. One of the most common things we have shifted in our overall approach is what is sagging versus what is the result of volume loss. In the beginning of my career as a surgeon, our goal was to always lift things because tissues would sag, and the options were more limited. Move the clock forward, we can actually do a lot more, and still get really nice outcomes without doing aggressive surgical procedures.
I do a lot of facelifts and classic cosmetic procedures for facial aging, but I have found that for someone like yourself, a conservative approach may be optimal, including an upper eyelid blepharoplasty where a small amount of skin in the hooding area in the side is reduced. Depending on whether or not the eyelids look low to you, and looking at what you looked like in the past, there may be some other options to explore. That said, the other areas we typically enhance such as the cheek and nasolabial fold you are concerned about, we actually do a lot with something called structural volumizing. Structural volumizing means placement of long lasting fillers at a deeper level along the bone structure so when the filler is placed, the bone structure is restored. One of the least appreciated things overlooked by both patients and surgeons is that bone loss is a significant part of facial aging, and that causes the face to go inward, and the tissue to go downward and inward, so restoring volume plays a big role.
I think it is important to get a full assessment to really understand what is optimal for you. When I evaluate my patients, I take photos from multiple angles, I review everything with them, and I try to help them understand the difference between sagging versus volume loss. We then we come together and work on a plan that will be optimal for them.
Meet with qualified, experienced cosmetic surgeons. Take good notes, and don’t get overwhelmed by the many different opinions you will probably receive. You have to be in the driver’s seat - decide what will look right for you, what level of invasiveness you’re comfortable with, but ultimately understanding the problem defines the solution. I hope that was helpful, I wish you the best of luck, and thank you for your question.
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Blepharoplasty or brow lift
To arrive at the best and most natural appearance, I believe you need brow lift and blepharoplasty. If you decide to have blepharoplasty alone as suggested by some of the answers below - be sure that the surgeon does not remove so much tissue in the lid that you would not be a candidate for brow lift in the future. It is difficult to determine from your photograph whether you have ptosis or not, but if so, this should be repaired. This would do nothing for the sagging of the cheek and nasolabial folds, but it would definitely enhance your eyes. You have good periorbital anatomy and bone structure - a good foundation for cosmetic lid and brow surgery. Your best option is to see an Oculoplastic surgeon for evaluation and treatment. Best wishes!
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