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Is Cosmetic Eyelid Surgery or a Brow Lift for Me?

Is Cosmetic Eyelid Surgery or a Brow Lift for Me?

Dale Reynolds, MD

Blepharoplasty, or cosmetic eyelid surgery, can be useful way to improve your overall appearance and diminish a haggard or tired look. Many people begin to consider surgery on their eyelids, or alternatively a brow lift, because they have a tired look about them even when they don’t feel tired. They are often asked by others if they are tired although they feel great.

In some patients, this begins early in their 20’s or even teens and is usually from darker skin in the area or from a prominence under the eyes which produces shadows giving the appearance of bags. This prominence is from excess fat around the eye itself. Redistributing or removing this via cosmetic eyelid surgery will remove the bags under the eyes. As the aging process continues, excess skin develops in the upper and lower eyelids. This usually becomes noticeable in the mid-forties and bothersome in the fifties.

Often, the excess skin in the upper eyelids can become such a problem that peripheral vision can be affected. Removing this excess skin from your upper eyelids during cosmetic eyelid surgery will significantly improve your appearance and will make you look more alert and more vibrant. If the skin was so excessive as to affect your peripheral vision, this will be corrected as well. Removing this excess skin from your lower eyelids will further improve the bags under your eyes, and in this age group, cosmetic eyelid surgery is usually done in conjunction with removal or redistribution of fat in the lower eyelid.

Approximately half of the patients that have excess skin in their upper eyelids could also benefit from a concurrent forehead lift (brow lift). Aging causes the forehead and eyebrows to descend causing bunching of the upper eyelid skin, and the excess skin in that area is accentuated by the descent of the brow. In these cases, if the brow lift is ignored, then there will only be partial improvement (usually around 75%). If a brow lift is performed, it can be done as an open procedure or as an endoscopic procedure. The open approach requires a longer incision but can often be hidden in the hair and is sometimes a better approach if the hairline is high. Numbness is more common with the open approach but usually resolves within a year. The endoscopic approach requires small incisions hidden in the hair, and the chance for numbness is greatly reduced. If the hairline is high, then caution must be used with an endoscopic approach because the hairline will be raised after the procedure.

If an extreme brow lift is required, the endoscopic approach may not be best. As with any procedure, there are risks that should be considered. There will be some asymmetry, swelling, and bruising for several weeks. Some patients are not candidates or are poor candidates for cosmetic eyelid surgery or a brow lift if they have excess laxity of their lower eyelid. These patients are at higher risk for ectropion (abnormal position of lower eyelid) post-operatively. If dry eyes are a problem before the brow lift surgery, then one should seriously re-consider surgery because dry eyes can become much worse post-operatively. If excess fluid has built up (edema) under the skin of the lower eyelid from an allergic response to the brow lift surgery, there may not be significant improvement with a lower blepharoplasty procedure. After an examination by your plastic surgeon, a recommendation will be made and risks complication will be discussed in detail taking into account your unique anatomy. Most patients are happy with the results after cosmetic eyelid surgery and look years younger. It can significantly improve a tired look and replace lost vibrancy to your face.  

 

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