How Do I Know if I Need an Upper Eyelid Lift or a Brow Lift?

Brow LiftSagging eyelids are a common problem that most people will experience with the aging process. Because the face functions as a single unit (meaning what occurs in the forehead affects the eyebrows and eyelids, which in turn can affect the lower face), it can be difficult at times to determine a single source for a particular concern. The truth is, it is the combination of sagging brows and excess skin on the eyelids that result in the sagging appearance of the eyelids. No two patients are alike, and it is important to tease out what is contributing to the sagging eyelids to determine which surgical repair is the most appropriate.

Upper eyelids lose elasticity over time and become redundant, giving them a tired appearance. For most women, this starts to occur in their early forties as they start to notice difficulty applying and visualizing their eye makeup. For men, it usually becomes a problem much later. When the redundancy is mild, it is mainly a cosmetic issue. When it becomes severe, it can sometimes interfere with a patient’s vision. Either case, the surgical treatment for this is an eyelid lift (blepharoplasty), where the excess skin, and usually the fat underneath the skin, is removed. This is a very common procedure that is performed and can significantly help to restore the rejuvenated appearance to the upper face.

A sagging brow should be approached with more caution, since a brow lift can significantly change the appearance and expression of the upper face. An aesthetically pleasing eyebrow usually rests at or slightly above the brow bone. For females, the outer aspect of the brow is slightly arched so that the tail of the brow is higher than the inner corner. For males, the brow tends to be essentially straight. With the aging process, the loss of skin elasticity and loss of volume from fat atrophy, result in sagging of the brows that can contribute to the sagging appearance of the eyelids. When the brows drop significantly below the brow bone, it will most likely need to be addressed surgically in order to enhance the results seen from a blepharoplasty.

There are several techniques to correct a sagging brow depending on the patient. Traditionally, a large incision across the hairline was required. There are still instances where this type of correction is needed, especially for patients with a severe droop across the entire length of the brow. Alternatively, a direct brow lift is where the incision is made immediately above the brow hairs and an ellipse of skin and soft tissue above the brows are excised and stitched closed. Although highly effective, it does leave behind a visible scar, thus making it ideal for male patients with thick brow hairs that can mask the scar. A modified version of this approach is to address the outer aspect of the brow, which leaves a minimal scar with good results. With the advent of endoscopic surgery, a brow lift can now be performed with just a small incision behind the hairline.

Many different options exist and each patient needs to be evaluated individually. A thorough preoperative examination by your surgeon is always necessary to determine which combination of surgeries would result in the best cosmetic outcome. Let the board-certified surgeons of the Emory Aesthetic Center help develop a plan that is tailored specifically to your desires and needs. Come in for your complimentary consultation.


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