Surgical Correction or Not to Correct Lagophthalmos from Brow Lift?

Fourteen months ago I had a brow lift (endotine implants). I now have lagothalmos in both eyes, (left eye 2mm short). I have mild upper lid asym. The "lago" caused chronic dry eye and I need ongoing treatment. My surgeon recommends lowering brows some to recover eye lid coverage. The more affected eye has slightly lower brow, not a correlation. My Opthamologist says surgery could make it worse. He recommends plugs or gold implants for affected eye. I have cosmetic and health concerns. Help!

Doctor Answers 7

Correction of lagopthalmos

If there is enough skin to allow the eye to close at this time, then reversing the forehead lift will likely not help. If that is the case a gold weight to help the lid drop might be a better choice. If the eye that is dry is the one with the higher eyebrow, you can try Botox or Xeomin ton that side only to see if weakening the muscle will allow the lid to close.

Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Lagopthalmus Following Brow Lift

Pictures would be helpful, but I have reversed the brow lift in some patients to correct the lagopthalmos which is the inability to close the eye. Most of these patients also had an upper eyelid blepharoplasty by their surgeon at the same time. As mentioned by others Botox is an easier solution that may improve the dry eyes.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Dry Eyes after Brow Lift

Dry eyes are very common, with or without plastic surgery. Lagophtalmos, a condition where the upper eyelid has difficulty closing, has several potential treatments. A implant in the upper eyelid (gold, platinum, etc) can allow gravity to push the eyelid down a bit. Tear duct plugs also keep the eyes moist. For some patients, Botox may possibly be used to help lower the eyebrow and upper eyelid. Lastly, reversing a brow lift with further plastic surgery may help. However, only after a comprehensive evaluation can a plastic surgeon or eyelid specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Correction of lagopthalmos

There are several ways to go about trying to correct this problem, altho I have never seen a case where an endo brow was able to left the lids that much without an aggressive upper lid blepharoplasty.  In plastic surgery we like to take a ladder approach.  Try the simple things first, you don't need an atom bomb to kill an ant.  I would try botox in the forhead to relax the brow.  If this works then you will need to go every 3-4 months for botox.  The next styep would probably be releasing the brows and endotines endoscopically and letting the brow go back to its original height.  This would also be good to do while there is a botox effect to let the brow drop as needed.  I would probably save the gold weight procedure as a last resort.  Make sure the problem is the brow and not over resection of eyelid skin.  Good luck, Dr. Schuster in Boca Raton

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 6 reviews

Lag after brow lift

This is a difficult problem and I suggest you consult with an eye plastic surgeon.  A few solutions are:

  • Botox to forehead to lower brows
  • Correction of any existing lower eyelid retraction or lower lid laxity
  • Punctal plugs as suggested by your eye MD

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Correcting Lagothalmous from brow lift surgery

I personally do not use endotine implants and I perform mainly endoscopic browlift procedures which do not typically have this post operative complication. With no photographs and no possibility of evaluation I will advise you to first follow the opthamologist suggestion and try plugs vs. any further surgery. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 208 reviews

Lagophthalmos after brow lift.

 I would need to see you to determine if reversing the brow lift would work. See an experienced plastic surgeon and an ophthalmologist for 2 opinions on how to proceed.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

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.