Conflicting advice on procedures - endo brow lift or temporal? (Photos)

Question

45 yo female looking to get rid of “tired” look. Consulted with several of the top ocular plastics surgeons here in LA/BH. All had slightly different recos. Not sure what’s the right approach..…all agree on upper bleph but some suggest endo brow lift while others say just do temporal. All said I have mild to moderate ptosis but didn’t think surgery was worth it. I know growing the temporal route saves the need for general but then not sure why others saying definitely need endo brow lift Thoughts?

Lucian Ion, FRCS · Answer

Thank you for your enquiry and for sharing your photographs. In general terms, eyebrow position tends to convey emotional expression more strongly than the eyelids themselves. Elevation of the brow opens the eye area in a different and often more expressive way, and for this reason a combination of procedures may be advantageous in your case.

In some individuals, lifting the tail of the brow can significantly reduce upper eyelid skin excess, occasionally to the point where upper eyelid surgery is no longer necessary. It is difficult to determine whether this would apply to you without an in-person assessment, but based on the photographs, a combined approach may be preferable.

To gain a practical sense of the difference between a brow lift and a temporal lift, you may find the following helpful. When lying completely flat and looking in a mirror, you will notice a general elevation of the entire brow, which roughly simulates the effect of a brow lift. In contrast, when standing and gently elevating the tail or lateral two-thirds of the brow, you will get a better impression of the typical effect of a temporal lift. This comparison may help you decide which approach best aligns with your aesthetic goals.

Gary M. Horndeski, MD · Answer

You have a very high forehead.  The distance between your eyebrow and hairline is too long.  I would use an open incision at the hairline junction to lower the hairline and raise the eyebrows.

Best Wishes,

Gary Horndeski, M.D.

Jeffrey H. Spiegel, MD · Answer

Here's more confusion for you. I likely do more browlifts than anyone anywhere. Based on your photos, your brows seem fine. An upper blepharoplasty alone (I'd do it in an hour in the office under local anesthesia) should be great for you.

Michael P. Morrissette, DDS, FACS · Answer

It appears that the majority of your aging upper eyelids is due to eyebrow ptosis. A browlift is going to make the most difference. You have medial brow ptosis and a great hairline so I would recommend a subcutaneous browlift that can be done in the office with light sedation anesthesia. This approach doesn't raise the hairline like an endobrow, and the results are more permanent with little chance of relapse. An upper blepharoplasty may also be indicated.

Conflicting advice on procedures - endo brow lift or temporal? (Photos)

Answers (4)

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