Today’s topic discusses the advantages of a Brow Lift over an Upper Eye lift. I have already spoken on the subject of the Brow lift, but a picture is worth a thousand words. The photo below illustrates how an Eye lift can cause crowding between the brow and the upper eyelid.
This patient had an Upper Eyelid lift, instead of doing a Brow lift. While it did open up her eyes, the brow still sags and her eyes are crowded near her eyebrow. In my opinion, a Brow lift would solve the problem in a much better fashion.
What are the signs and symptoms for a Brow Lift?
Many young women come to my office when they start noticing a little bit of ‘extra skin’ on their eyelids, or sagging upper eyelids. They have heard about eye lifts (blepharoplasty), and how easily it can be performed- under local anesthesia.
Naturally, they are very interested because the procedure is performed in the office and takes only 1-2 hours. However, the Upper Eyelid lift is not an ideal procedure. I don’t think the results are as good as a Brow lift. Furthermore, if too much skin is taken off, the eye lids will have a had time closing and the patient can suffer with dry eye syndrome.
In fact, I usually prefer to perform a Brow Lift instead of an Upper Eyelid lift in order to achieve a better result. The Brow Lift will elevate the brow to it’s youthful position, and in the process it will lift the upper eyelids. The result is a refreshed natural appearance.
Undesirable effects of an Upper eyelid lift
While I am not against Upper eyelid lifts, I counsel patients to think very carefully about it, because eye lifts can have undesirable effects. For example, after an upper eyelid lift some patients have a ‘crowded’ look around the eyes that is not necessarily youthful.
Look at the two pictures above, the picture to the left is before eye lift surgery and the one further down and to the right is after eye lift surgery. The red arrow on the left eye is the same size in both pictures. What you will notice is that the distance between the brow and the eyelid shortened markedly in the after surgery picture. This creates a more “crowded” look around the eyes, certainly not the more open look of youth.
Why does my brow sag?
There is a reason your brows sag with age. When your eyes try to focus, you ‘squint’ your eyes, or squeeze your eyelids closer to focus better. Since the eyelid muscles are connected to the tissues of the brow, repeated gestures and gravity will bring the brow down. This bunches up the skin above the eyelashes.
But this is not ‘excess’ skin, it is only bunched up because the brow came down. The eyelashes feel the weight of the ‘excess’ skin pushing down and send the brain a signal to lift the brows in order to get the ‘excess’ skin out of the way. This is how you get forehead wrinkles. It comes from years of repeated gestures of lifting the brow to get the skin out the way.
Upper Eyelid Lift complications
If you cut away the ‘excess’ skin with an Upper eye lift, the brow no longer needs to be lifted so it relaxes and drops again. That is why the distance between the brow and the eyelid is shorter in these ‘after eye lift’ surgery pictures.
That is also why some patients complain after surgery that ‘not enough skin was taken off’. What happened is not that the surgeon took too little skin off, but that the brow dropped some and now skin is bunching up again. On the other hand, if the eye lift surgeon cuts more skin away, you run the danger of the eyelids not closing properly, allowing the tear film to dry too fast, and irritating the eyes. This is called “dry eye syndrome”.
In a nutshell the problem is not really ‘excess’ eyelid skin, but a lower brow position which has fallen with age. So, I prefer to concentrate more on lifting the brow to it’s youthful position.
Brow lift is the alternative to the Upper eyelid lift
In order to refresh the eye to a natural position, the brow needs to be lifted. This will have the effect of lifting the upper eyelids. For this reason I prefer an endoscopic brow lift. Scars are minimal, recovery time is minimal (7 days), and it has a better result. After the Brow lift patients look refreshed and youthful. It is so natural that oftentimes friends will tell patients, “you look so rested and happy!”.
(originally published October 14, 2007)
