Internal Brow Lift with Upper Eyelid Surgery?

Question

I have interviewed several doctors concerning surgery on my upper eyelids. All of them said I would only need excess skin removed but one of them suggested doing an internal brow lift at the same time. I am already nervous about this operation and don't want to do anything that would add more risk or a longer recovery time. Would having an internal brow lift do this? Also, if my brows are sutured to my forehead will it look strange as I continue to age?

Lawrence Kass, MD · Answer

In my opinion, and as someone who does an awful lot of these procedures, it won’t make a lot of difference either way. An internal brow procedure doesn’t really lift the brow so much as it prevents slight descent resulting from upper eyelid surgery. It is not really the same as an aesthetic forehead or brow lift procedure. If it increases your anxiety about having the procedure, I would counsel you to pass on it. You will likely be well satisfied with the results of your eyelid surgery alone.

Ricardo L. Rodriguez, MD · Answer

Sometimes the brow droops such that it crowds down on the upper eyelids, making you feel as though you have excess skin in that area. However, sometimes instead of reducing the amount of skin covering the eye, the most natural way to fix the problem is to raise the brow.

	If you feel like you have too much skin in the upper eyelids, raise your brow to a level just above the bony ridge over the eye. If there is still excess skin, it would be great to have just upper eyelid surgery. If the excess skin is mostly gone, think seriously about repositioning the brow to its more youthful position.

Stephen Prendiville, MD · Answer

Generally speaking, and upper eyelid Blepharoplasty (in isolation) will decrease the distance between the upper eyelid crease and the eyebrow, thereby lowering the brow somewhat. This is an acceptable trade off is some patients and not in others; only a thorough examination can determine this. A well performed brow lift should make you look better, more relaxed, but not "strange". Personally, I am not a big fan of the trans-Blepharoplasty brow lift; an Endoscopic or Trichophytic approach offer a more complete result.

Toby Mayer, MD · Answer

The answer depends on your eyes and brows and the surgeon's skill. I do a brow lift that does not make the patient looked surprised with or without doing upper lids in 80 percent of my caucasian patients. Without photos it is difficult to say. If you have hooding at the sides of your eyes you probably would be a browlift candidate.

Mark Beaty, MD · Answer

When considering upper facial rejuvenation brow position is an important part of the overall evaluation. Without photos it is difficult to offer any insight on the need for browlift in your case but many patients do benefit from concurrent brow and upper eyelid surgery. Recovery time is generally similar with or without browlift.

William Portuese, MD · Answer

In our practice we perform a browlift through an incision in the forehead so that we can adjust the hairline upwards or downwards, lift the eyebrows, adjust asymmetries in the height of the eyebrows, and soften the corrugator and frontalis muscles which cause wrinkles in the forehead. When the wrinkles are severe enough,  we insert fascia grafts for the dermal atrophy. A brow lift can be combined with an upper eye lid surgery when needed. For many examples of both procedures, please see the link and the video below

Philip Young, MD · Answer

Brow lift and Eye lift are two major ways to rejuvenate the upper third portion of the face. You could be a great candidate for a brow lift if the distance from your eyelid margin and eyebrow is less than 1 iris width (the colored part of your eye).  This distance is ideally one iris width. If the brows are elevated above one iris width you could look surprised. An eyelift will remove extra tissue from your eyelid and also help. 
	The recovery is substantially longer with a browlift as opposed to when you just do an eyelift.  An eyelift is relatively much easier to recover from.  The browlift requires much more dissection and more trauma and stimulation to your tissues.
	Thanks for reading, Dr Young

Craig Harrison, MD · Answer

Dear Boise495,

	Hard to advise without photos.  I suggest that you ask the "brow lift" surgeon to show you photos of the results from his brow lift done on some other patients.   You might be able to better see if you would like the change that he expects.  Good luck.

Daniel Greenwald, MD (in memoriam) · Answer

Whether or not to perform a browlift in conjunction with upper lid lifting is determined by these things:

	brow position relative to the top of the eye socket;

	brow shape and orientation;

	the degree to which descent of the brow contributes to excess upper lid skin.

	Be aware: when excess upper eyelid skin is removed eyebrows sometimes fall.  This is because once the eyes are more easily held open the muscles that raise the brow can relax, lowering the position of the brow on the face.  Interesting, no?

	The key is to make an accurate diagnosis: if the brow is below the orbital rim, raise the brow.  If not, just do the lids.  All else is in the realm of the cosmetic browlift, not the cosmetic eyelidplasty.

Lisa Lynn Sowder, MD (retired) - Account Suspended · Answer

Brow position is super important and if you brows are indeed low, you would likely be well served with some sort of brow lift.  If only the eyelid surgery is done and your brows are too low, the eyelid surgery may pull your brow down some and it will not give you the best result.  Also, if too much skin is removed, a brow lift in the future may not be possible.  Be sure the two docs who said no to brow lift acutally know how to do a brow lift.  There are some doctors who claim to be plastic surgeons who do not know how to lift a brow.  If it's not in their tool box, they won't offer it or may not even know the proper indications for a brow lift.

	Lisa Lynn Sowder, M.D.

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