Eyes and Brows

Has your forehead developed deep lines? Have your eyebrows begun to descend? Have your upper eyelids accumulated excess skin and lines, while your lower eyelids became wrinkled and puffy? If you answered yes to any of these questions, you have started to notice the signs of aging in your eye and brow area. I perform brow lift and eyelid surgery at my Dallas plastic surgery practice to minimize the signs of aging in my patients and rejuvenate their appearance.

Brow Lift

Very few patients will see a plastic surgeon and complain about the position of the brow or forehead. Nevertheless, there are several reasons why brow lifting may be appropriate.

The natural aging process affects the brow as much as the rest of the face, resulting in wrinkled, hanging skin and descent of the eyebrows. However, the frontalis muscle (forehead muscle) frequently compensates for brow sagging by actively lifting the eyebrows. Continued contraction of the frontalis muscle to lift the brow causes deep furrows or lines in the forehead. Even if the eyebrows are in a good position, the presence of significant forehead lines indicates that a brow lift is necessary to allow the frontalis muscle to relax and diminish these lines. Furthermore, removing skin from the upper eyelids (as in blepharoplasty) can frequently cause the eyebrows to descend lower unless a brow lift is performed to support the brow position.

Brow Lift Goals

  • Maintain or elevate the position of the eyebrows at a more attractive, youthful level
  • Minimize the appearance of transverse (horizontal) forehead wrinkles
  • Minimize the appearance of the central vertical brow wrinkles which are caused by the frown muscles

A brow lift can also reduce the size of an overly long, tall forehead. A brow lift should not overly elevate the brows or leave patients with a “surprised” look.

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3 Board Categories of Brow lifts:

1. Coronal Brow Lift

The coronal brow lift (sometimes called “open” brow lift) involves a single incision beginning in the hair at the ear and extending across the scalp, several inches behind the hairline, to the opposite side. The brow is released from its attachments along the bony prominence above the eyes, surgically manipulated to inhibit the effects of the frown muscles, the excess skin is removed (behind the hairline) and the incisions are closed with surgical staples.

2. Hairline Brow Lift

A hairline brow lift is similar to the coronal lift, except that a portion of the incision is made at the hairline. This modification is necessary in patients with “tall” foreheads and high hairlines to prevent or correct an excessively high hairline. After a brow lift, there is numbness behind the incision in the scalp that persists for several months. I recommend hairline brow lift to the majority of my patients

3. Endoscopic Brow Lift

In an endoscopic brow lift, three to five much shorter incisions are made in the scalp at or behind the hairline. The brow is still released from its attachment at the bony prominence above the eyes, with the assistance of an endoscope (video camera through a small incision) and surgery is still done to inhibit the effects of the frown muscles; however, minimal or no skin is removed; instead, the brow is elevated and suspended from tiny absorbable screws placed in the bone. These screws are made from a material similar to absorbable stitches and absorb over a period of months. By the time the screws absorb, the brow has adhered to its new, elevated position. The endoscopic brow lift has the benefits of shorter incisions and decreased amounts of numbness; however, it is not for everyone. Endoscopic brow lifts tend to give less brow elevation and there is a higher incidence of recurrent brow ptosis (brow sag and descent to a lower position).

Eyelid Surgery (Blepharoplasty)

Because the eyes occupy central prominence in the face, people often form first impressions based on the appearance of the eyes. Tired, aged appearing eyes result from excess fat, excess sagging skin and/or muscle, lax or sagging supporting tissue or a combination thereof. These problems may be primarily the result of natural aging, or there may be a familial, genetic predisposition. The resulting eyelid deformities are difficult, if not impossible to camouflage (with makeup, for example).

Blepharoplasty is the term for surgery of the upper and/or lower eyelids to correct these eyelid deformities. Historically, blepharoplasty involved incisions in the upper and lower eyelids, with removal of variable amounts of skin and fat. This frequently produced good early results; however, in the long run, removal of too much fat leaves the eyes appearing hollow, sunken and definitely not youthful.

Today, we surgeons realize the importance of preserving the fat around the eyes as much as possible. Bulging, puffy lower eyelids are frequently due more to loosening of the supporting structures of the eyelid than to true excess fat. I carefully remove any excess fat and then surgically tighten and reinforce these supporting structures to soften and smooth the transition between the eyelid and the cheek. Excess upper and/or lower eyelid skin is then removed. Blepharoplasty will not remove or erase each and every small line around the eyes.

Risks and Complications

Eyelid surgery and brow lift involves the same consultative process at my Dallas practice and similar risks to the facelift procedure. Eyelid surgery also carries with it specific risks. Very rarely, significant bleeding can occur in the space containing the eye. When this happens, the eye becomes extremely swollen, bruised and painful. You should notify my office immediately if this occurs so that stitches can be removed to relieve the swelling. This condition is extremely rare. If excessive skin is removed from the eyelids, irritated, dry eyes may result which may necessitate the use of drops. If excessive skin is removed from the lower eyelids, the eyelid may lose contact with the eye, roll outward and result in irritation. This condition is rare and usually responds to massage, resolving over a period of three to six weeks. Slight eversion (turning out of the lower eyelid) after eyelid surgery is common in the first three to four days and resolves as swelling subsides.

I tend to recommend that my Dallas patients undergo eyelid surgery and brow lift in combination. Even though your brow may be in a good position before surgery, eyelid surgery without brow lift may lead to a lowering of your brow position and a more unbalanced appearance after surgery. I will discuss all of these concerns with you during your facial rejuvenation consultation. To schedule that consultation with me, contact my practice today.


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