Brow Lift

Brow Lift Versus Eyelid Lift: Which One Do I Need?

eye-checkAre you tired of looking tired? As we age, excess skin or drooping brows can cause our eyes to lose their sparkle, leaving us looking chronically fatigued. You may assume that the problem is excess skin on your eyelids—and you might be right. However, sometimes the reason is more complex. If your eyebrows have drooped, they may be causing your eyelid skin to bunch up and even crowd your eyelashes.

So, do you just have to go through life looking exhausted? Fortunately, no. Eyelid lifts and eyebrow lifts are two options that can immediately enhance the appearance of your eyes and bring back your natural sparkle. Emory Healthcare cosmetic surgeons can help you determine if you’re a candidate for an eyelid lift, a brow lift or a combination of the two.

Do I Need an Eyelid Lift?

If the issue is skin excess in your upper lids alone, without any need for change in brow position, an upper eyelid lift may be all you need. This is a relatively simple and low-downtime, cost effective way to improve the brightness of your eyes. In some cases, it can even be performed under local anesthetic.

Do I Need an Eyebrow Lift?

You may be wondering how you can tell if your eyebrows have drooped. Well, ideally, a woman’s eyebrow should start in a gentle curve above the top of her nose and rise above her orbital bone (brow bone) until it peaks at the outer edge of her eyelid. Then, the brow should gently curve out and slightly downward. The entire course of her brow is preferred to be at, or slightly above, her brow bone and both brows should be relatively symmetric.

Many people hold their eyebrows up to compensate for drooping, without even realizing they’re doing it. In order to assess if this is the case for you, stand in front of a mirror and close your eyes. Take a deep breath in and out and purposely relax your brows and forehead. Open your eyes slowly, taking care not to raise your forehead, and look at your eyelids and brow position. If your brows seem to have dropped lower than you thought they were, it’s likely that you inadvertently hold them up and may benefit from a brow lift.

Although a brow lift may sound invasive or complicated, the procedure is actually not particularly high-risk or painful.

How Will I Look After an Eyebrow Lift?

To imitate the effect of a brow lift, watch in a mirror as you take your fingers and place them between your eyebrows and hairline. Gently lift a little to see how your brow position changes and if excess skin on your eyelid is reduced. If doing this improves the skin excess at your eyelids and makes a favorable change in your appearance, a brow lift may be the right option for you. If there is still excess skin on your eyelids, even as you’re gently pulling, your surgeon may recommend a combination of eyebrow and eyelid lifts for best results.

What Can I Expect?

Satisfaction rates for brow and lid lifts are high and the downtime can be as little as five to 10 days, depending on your individual surgery. Results usually last many years and don’t often need to be “tucked up” in the way that some other plastic surgery procedures require.

Eye Enhancement at Emory Aesthetic Center

If you’re considering rejuvenating and improving the appearance of your eyes, come see one of the board-certified physicians at Emory Aesthetic Center for a complimentary consultation. We can discuss your goals and determine what treatment is right for you.

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Ask the Doctor: What is the Difference Between a Forehead Lift and a Brow Lift?

looking-upIt is not surprising that cosmetic surgeons are often asked what is the difference between a brow lift and a forehead lift. After all, both descriptions involve the same area of the face, and both imply a lift. The brow is considered the hairy part right above the eyelids – the eyebrows, and the forehead is the area between the eyebrows and the scalp. Most patients, and even plastic surgeons, may use these terms interchangeably. Both of these terms describe a procedure intended to smooth and lift the skin of the forehead, and to lift and reposition the brows. How this works, however, is different for each of the areas.

In order to highlight these differences, it can be helpful to compare a brow lift or forehead lift to a facelift. When a facelift is performed, the pulled skin stretches fairly evenly, with the effect seen over the entire length of the face. It is similar to pulling a rubber band that is anchored on one end. In the forehead, however, the skin is thicker and less elastic. When the forehead is pulled, there is much less stretching of the skin.

In order to smooth and lift the skin of the brow/forehead, your surgeon will first gently create a separation between two of the tissue planes of the forehead, allowing them to glide on each other. Your surgeon will also release the attachments of the brows so that they can more freely be moved to the desired position, and then the tissues are then fixed in their new position.

So far, so good . . . but you may be asking, if the forehead skin is not stretched out very much, why do the wrinkles in the forehead get better? That is an interesting question, and the answer is equally interesting. The horizontal wrinkles in the forehead are not static – rather, they are dynamic. In other words they result from the activity of the underlying muscles that work to lift the brows. When the brows are lifted by surgery, then these muscles calm down and become less active because the stimulus to lift the brows is reduced. In addition, a brow/forehead lift often removes the muscles that are between the eyebrows. These muscles, called the corrugators, are the cause of the vertical wrinkles – also known as the “11s”. The corrugators and the muscles that lift the forehead tend to work against each other, so when the corrugators are weakened, the muscles that create the forehead wrinkles tend to work less, also helping the wrinkles to fade.

There are many different brow/forehead lift techniques that you and your cosmetic surgeon can consider depending on your individual needs. In most instances, an endoscopic approach allows for very small incisions hidden in the hairline. But there are some instances where an endoscopic approach can be combined with an incision in the eyelid performed along with an eyelid lift. And although not as common, an incision hidden along the hairline can actually lower the forehead while the brows are being raised in patients who have very high foreheads.

While we tend to use the terms brow lift and forehead lift synonymously, there are procedures where the brow is directly lifted but the forehead is not. A direct brow lift is rarely done, but works by removing a strip of skin along the upper border of the brows. This creates a scar in this area, however this technique can be used in the elderly as these scars may fade well. Another technique is to perform a browpexy, where sutures are placed using an eyelid incision to sew the undersurface of the brow to the bone. This can create a nice elevation of the brow, although it is less powerful than a full brow/forehead lift. As you can guess, this latter technique is most often combined with an upper eyelid lift.

The terms brow lift and forehead lift are used practically to describe the same thing. But what is more important than the terms, is the need to consult with your surgeon to make sure the strategies and techniques they use are best suited for your goals and anatomy. At the Emory Aesthetic Center, our multi-disciplinary team of board-certified physicians can help you navigate all the terms and decisions to come up with a treatment plan custom tailored just for you.


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About Dr. Eaves

eaves-iii-felmontDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Defying Gravity: Surgical and Non-surgical Treatments to Prevent Aging

crunchesPatients ask me all the time…”How do I fight off the effects of gravity, and do I need surgery to do that?” The good news is that we now have more tools than ever before to defy the effects of aging. In order to get the best results, it is essential to know what each tool can do, but perhaps even more importantly, what it cannot do. By picking the right tool for each area of your body – whether surgical or non-surgical – you will have a better chance to get the result you are seeking.

As we age, the loss of elasticity of our skin results in the appearance of sagging. Brows can look low, eyelids can sag, and jowls invade once beautiful jawlines. Laxity in the neck can result in drooping that is especially noticeable when looking down or in pictures taken from the side. Sagging of the breasts, technically known as breast ptosis, may result not only from aging and the effects of gravity, but from the after-effects of pregnancy and breast feeding. Pregnancy can have a profound affect on the tummy area and can lead to loose skin as well as separation of the muscles which leads to an appearance of rounding. Weight fluctuations can also have a profound effect. If you gain and loose weight frequently, and especially if you loose a large amount of weight, the laxity and sagging will be much greater, particularly contributing to laxity in the tummy and thighs.

Non-surgical treatments have a critical role in preventing aging and the effects of gravity, but when actual sagging occurs, surgery is typically the best and often only solution to get the changes you want. Currently non-surgical treatments have little capacity to tighten loose skin, particularly in the body region. But non-surgical treatments can do a wonderful job addressing wrinkles due to muscle hyperactivity (Botox®), of softening the appearance of deeper creases in the face (dermal fillers), of reducing isolated areas of fat accumulation (CoolSculpting®), and improving the texture and appearance of the skin(skin care, lasers, chemical peels).

In the face, if you really want to tighten sagging jowls, lift a droopy brow or eyelids, or to address loose skin in the neck, surgery is definitely the way to go. A brow lift can reposition the brows and help create a more open, bright look to the eyes. An eyelid lift can smooth the skin of the upper eyelid or soften the appearance of “bags” of the lower eyelid. A facelift can improve the cheek contours and reduce jowls, creating a more youthful, smooth jaw line, and a neck lift can tighten and smooth the neck. While surgery is the dominant solution for defying gravity in the facial area, there are situations where non-invasive procedures can play a role. For example, if a patient has very early jowling and isn’t yet ready for a face lift, placing fillers along the edge of the jowl and along the jawline can camouflage the appearance, although it will not “lift” it away. If a patient has lost volume of the upper cheek area, injecting the area with fillers can replace volume and give the appearance of lifting the midface.

In the facial area it is extremely common to combine surgical and non-surgical approaches to optimize your results. For instance, while a face and neck lift will help you defy the effects of gravity, the surgery will not change the overall appearance of your skin. A skin care program can work wonders to enhance the results of your surgery by smoothing rough spots, evening the color of your skin and reducing dark spots, shrinking pore size, and creating a healthy glow to your skin.

In the breast and body areas, non-surgical approaches have little to offer in terms of actual lifting of tissues in order to defy gravity. This is because current technologies do not sufficiently tighten skin to create dramatic improvements, nor can they effectively tighten the soft tissues under the skin. If you really want to tighten sagging tissue back to its youthful position, surgery is required. In the breast, this means undergoing a breast lift (mastopexy) either with or without implants. In the tummy area, this means an abdominoplasty (tummy tuck) with or without liposuction. In recent years, buttock lifts and thigh lifts have become increasingly common.

While there are plenty of non-surgical technologies being marketed that tout skin tightening, they have not been proven to work. In fact, some of our patients have said they tried these treatments, especially in the body areas, and most felt that they had either no result or that the results were so minimal that it was not worth the investment.

If you are interested in counteracting the effects of gravity, come and consult with one of the board-certified physicians at the Emory Aesthetic Center. We can go over options specific to your individual needs, and help you understand which surgical or non-surgical treatments are best for you.

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or call us at 404-778-6880 to schedule a consultation

About Dr. Eaves

eaves-iii-felmontDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

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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From Face to Breast to Body: Understanding Aesthetic Surgery

Understanding Aesthetic SurgeryThere is a deep and rich science related to the understanding of the origins, importance, and impact of physical appearance on our lives. Research tells us that as human beings our appearance not only plays a role in how we view ourselves, but it also plays a role in our interaction with the world. Therefore, it is not surprising that in addition to grooming, makeup, and exercise, cosmetic procedures and surgeries have become a popular option to millions of women and men every year.

Although we don’t consciously think of beauty in this way, science teaches us that there are four primary ways in which we care about our appearance. They are youthfulness, symmetry, gender, and normal development. If we think in these terms, it becomes easy to understand that aesthetic surgery of the face, breasts, or body is similar and follows similar patterns.

For instance, as we age our skin and soft tissues loose tone and elasticity. In the face we see it with loose skin, the development of wrinkles, and by tissue drooping. These same kinds of changes can also lead to drooping of the breasts, abdominal skin, and bottom. The most common way to reverse these changes is to “lift” loose tissues. “Lifting” can actually mean pulling up an area, but it can also mean tightening the area by removing some of the loose skin and tissue, so that what is left is pulled tighter. Lifting is a common technique that is used in the face (think brow lift, eyelid lift, or neck lift), breasts (breast lift), and body (think body lifts – tummy tucks, thigh lifts, buttock lifts). Pulled tighter, the lifted area looks more youthful to us.

Youthfulness also correlates with a more fit, athletic appearance, so it is not surprising that fatty deposits bother us, whether it is under the chin, in the “bra roll” area adjacent to the breasts, or on our tummies or thighs. When we can’t fix these areas in the gym, perhaps we can help them with a surgical procedure to remove the unwanted bulge. In a similar way, fat in the right places and the right amounts is a sign of youthful vigor. A full face, full breasts (in a female), and full buttocks are all healthy and are considered to be of youthful, if not too full. With aging and changes in weight, these areas can look either too full or too deflated, so taking away tissue (e.g. liposuction) or adding tissue (e.g. fat grafts) can be used to create more desirable proportions, regardless of the part of the body.

Symmetry is also very important to our concept of attractiveness. Most of us are aware that we may have one foot or hand that is bigger than the other, but other areas such as the face, breast, or body can also demonstrate asymmetry. If one side of our face is smaller than the other, we might seek to correct this with fillers to create more balance. Or if one brow is lower than the other, we might try to correct this with Botox® injections or a brow® lift. Breast asymmetry can be particularly concerning to women, and fortunately this can often be addressed when performing a breast cosmetic procedure. If a patient is interested in increasing the size of the breasts with breast augmentation, size asymmetry can be corrected by putting a larger implant on the side that was initially smaller. If a patient wants breast reduction or to reduce her breast size, the larger side can be reduced more. If the asymmetry is in the form of one breast lower than the other, the lower breast can be lifted more. In the same way, if one thigh is bigger than the other, more liposuction can be done on the larger side. At the extremes, very significant differences in breast size, position, or contour can relate to problems with normal development, so correction in these situations can be particularly rewarding to patients.

Gender is a further key aspect of how we assess our appearances. Men want to look and appear as attractive men, and women want to look and appear as attractive women. Gender differences naturally occur in all areas of our bodies. For instance, in the face men naturally have heavier and lower brows, while women naturally have finer, more delicate and higher brows. Women often address the brows by selective plucking to shape and refine, and a brow lift can restore normal brow height. These characteristics, however, also help guide us as surgeons to what we may want to avoid. In a man who wants to lift his brows to reverse the drooping of aging, we need to be careful not to elevate the brows too much as this creates an overly feminized appearance. In men, the development of a feminizing appearance to the breasts is particularly unsettling, and at the same time is quite common, especially with aging. This development – known as gynecomastia – can be successfully treated by liposuction in most cases. Your surgeon must remain aware of gender differences when contouring your body as well. Too straight of a waist in a female tends to look a bit masculine, while to much “curve” looks feminine on a man.

As you can see, aesthetics of the face, breast, and body follow many of the same patterns, and a lot of the same strategies are used from area to area. Let the Emory Aesthetic Center help you think through your particular concerns and develop a plan that is tailored specifically to your desires and needs.

About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

New Year Refresh: Solutions to Remove Years of Aging

Remove Years of AgingAh . . . the New Year is already upon us, and while we take time to reflect on the year that just flew by, many of us are also looking at our reflection in the mirror. Perhaps that reflection is looking a little tired . . . worn . . . older than the energy you feel inside. Now is a great time to think about what you can do to refresh and rejuvenate that reflection, and get ready for your best year. More than ever before, there are many options to help you achieve this goal.

When you want your face to glow, you can’t ignore great skin care. It is that ongoing skin care that creates a base for everything else you might do for your face. Skin care means really protecting your skin from the sun with the right kind of sun block. It means using the right kind of moisturizers to keep the skin well hydrated. It may mean using targeted cosmeceuticals like retinoids, fruit acids, and other treatments to address fine lines, pigment irregularity, or texture changes. Getting on the right skin care regimen doesn’t have to be complex and it doesn’t have to be difficult – in fact it should only take a few minutes a day – but getting on the right regimen does take expertise. Working together with our licensed aestheticians of the Emory Aesthetic Center Spa, we can help you find the right mix of products tailored for your skin type.

In addition to the base of skin care, there are exciting technologies that you can use to make significant changes in your skin appearance. Lasers, IPL (intense pulsed light), and other energy based devices can tighten skin, fade dark spots, and treat those pesky broken veins. Facial peels can also be used to the same end, but depending on your specific needs, may need to be done in a series – peels are usually milder with minimal down time but may require a building up effect over multiple treatments. Or perhaps you might be a good candidate for a surgical peel or laser that may complete the treatment in a single stage. One newer technology that we’re very excited about is micro-needling, a process that combines tiny needles to stimulate collagen formation and the penetration of growth factors to rejuvenate the skin. Micro-needling takes only a few minutes and you’ll be able to put on makeup and be out the next day.

In addition to great skin care, injectables are highly effective treatments to smooth out wrinkles, grooves, or depressions. These minimally-invasive treatments come in two main forms – those that weaken the muscles that help prevent wrinkles, and those that fill in deeper wrinkles or plump up areas of the face. The “toxins,” such at Botox®, reduce the activity of the muscles of expression. They are used primarily to treat wrinkles of the forehead, between the eyebrows, and the “crow’s feet,” which are the wrinkles from squinting that occur at the corner of the eyes. There are several types of fillers which can be chosen depending on the individual needs and areas to be treated. Typical uses of fillers are to fill out the cheeks, soften the look of bags under the eyes, or to fill in the grooves near the nose and corner of the mouth. While Botox® may take a few days to develop effect, many of the fillers demonstrate an immediate effect. Both types of injections are done during an office visit and you can resume normal activities immediately.

As wonderful as skin care and minimally-invasive treatments are, there are some aesthetic goals that only surgery can produce. Need to get rid of those jowls? Is the skin under the chin loose and saggy? Is the skin of the eyelids loose and droopy, or is the brow low? In these kinds of situations, surgery comes to the rescue. A face lift or neck lift, a brow lift, or a blepharoplasty can provide long-lasting and dramatic results, and the recovery time may be a less than you think.

Depending on your age, skin type, genetics, sun exposure, and other factors, there are many potential treatment options to help you achieve the changes you want. To get the very best results, it is important to come up with a comprehensive game plan that is tailored specifically for you and your individual needs. The game plan may include minimally-invasive treatments like Botox® or fillers, it may include surgery, or it may just require routine skin care and products. The Emory Aesthetic Center can help you pull all these pieces together to create a strategy just for you. Come in for your complimentary consultation.

404-778-6880
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About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

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Non-Surgical vs. Surgical Facial Rejuvenation: Which is Right for Me?

Facial Rejuvenation OptionsOver the past several years there has been an explosion of options to help your face look better and younger. Fillers, toxins (e.g. Botox®), stem cells, facelifts, fat grafts, skin tightening, and the list goes on and on. With so many options, how can you know what is right for you? Is surgery better, or will non-surgical treatments help you achieve your goals? Do the treatments even work? As you consider your options, understanding a few general principals can help simplify the decision.

First, it’s important to understand that surgery and non-surgical procedures sometimes do different things, but sometimes they do the same thing in different ways. For instance, deepening of the nasolabial folds (the creases from the side of the nose toward the corners of the mouth) can be softened by dermal fillers such as hyaluronic acid (e.g. Juviderm®, Restylane®). This type of injection is performed during an office visit and only takes a few minutes. Surgery, however, can also diminish the folds. Fat grafts can be utilized to soften the folds much like fillers, and often the most dramatic improvement to the folds is when a face lift is combined with fat grafting.

Second, while non-surgical or minimally-invasive treatments are easy to undergo and recover from, they are typically temporary and will need to be repeated to maintain the effect. Neurotoxins (e.g. Botox®, Dysport®, Xeomin®) do a great job of softening wrinkles between the brows, in the forehead, and by the side of the eyes, e.g. ‘crow’s feet’. These injections take only a few minutes to complete, but they typically last about 3 or 4 months and then need to be repeated to maintain the effect. On the other hand, surgical procedures tend to be more long lasting and may never need to be repeated. A brow lift can treat the wrinkles between the eyebrows extremely well, and this improvement is generally permanent.

Third, there are some aging changes that simply can’t be adequately corrected by non-surgical treatments, at least at this point in time. If you have developed significant jowling, only surgery can reliably address this issue. If the brow position is quite low or there is a significant amount of loose skin of the upper eyelids, only eyelid and brow surgery can reliably reposition the brow or eliminate the loose skin of the upper lid. If there is significant skin laxity in the neck, minimally-invasive treatments will not fully correct the looseness, and a neck lift will be required for full correction.

It is also very important to understand that often non-surgical and surgical treatments represent a continuum of effectiveness. Office chemical peels, mechanical treatments, or facial lasers can do a great job if the degree of skin changes and wrinkling is relatively limited. More aggressive lasers or surgical chemical peels, however, can produce more dramatic results when the skin has more established aging. Very often, minimally-invasive treatments are a great option for less severe changes, while surgical treatments are the best for more severe changes. If you are older and have more advanced aging concerns, surgery is more than likely the answer for you, but if you are in your thirties or forties, very often the non-invasive treatments such as fillers, Botox®, and good skin care is the best strategy.

Finally, and most importantly, marketing and hype doesn’t mean that something works. As much as we are always hoping for great, new options, some of the marketed treatments have little or no proven effect. For example, although the potential of stem cells to treat many conditions – including facial aging – is significant, at this time there are not sufficient studies to show that the currently marketed treatments are either safe or effective. Also, just because a treatment is approved by the FDA doesn’t mean that it is better than the older, simpler, or less expensive procedures. The old adage is upheld: If it seems too good to be true, it probably is.

As you work to figure out your best combination of options, remember that the doctors at the Emory Aesthetic Center are trained in both non-surgical and facial surgical solutions to address your aging concerns, and can help you figure out what strategy is best for you. In addition, we can help you develop a long-term, integrated plan to keep your face looking its best, incorporating good skin care along with non-invasive and surgical treatments when the time is right.

Join us for a live chat on Facial Rejuvenation –Surgical and Nonsurgical Solutions on Tuesday, November 11th at Noon to hear more about this topic. Dr. Foad Nahai, cosmetic surgeon, will be available to answer all of your questions. To register for the live chat, click here.

About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Understanding Endoscopic Brow Lifts

Eyebrow LiftAs we age, parts of our body start to droop – gravity and time seem to spare no one! Much of this results from loss of volume and laxity of the skin occurring in both the face and the body, becoming a concern for many people.

One area of the face that can be bothersome is a sagging brow. As our brows droop, it creates an aging look and can make us appear sad, tired or angry. Wrinkles in the forehead can then deepen as we try to lift our brows to help counteract this look—this action can be an unconscious drive that we aren’t even aware of. A brow lift can help rejuvenate the face, especially in the upper part, and can ensure your expression on the outside matches your inward emotion.

Though there are many ways to lift a brow, the endoscopic brow lift approach is one of the most cosmetically appealing, since visible scars on the face will not occur. This technique has been around for a number of years and has replaced more conventional methods for brow elevation, especially when related to aesthetic concerns.

The endoscopic brow lift procedure involves making 3 to 5 small incisions above the hairline to allow for release of tissue along the forehead, under the brows and out to the sides. As the release gets closer to the brows, a scope is introduced to allow direct visualization of important nerves so as not damage them. Also, the muscles in between our brows that create an angry look when we frown can be weakened or redraped to create a smoother central forehead. Once the soft tissue of the forehead is more mobile, it can then be contoured to a more youthful position. A brow lift is typically performed under general anesthesia and takes one to one and a half hours to complete. The upper eyelids may be bruised and swollen for one to two weeks following surgery.

Although the endoscopic brow lift is a very effective approach with high patient satisfaction, the Emory Aesthetic Center also performs other lift techniques to this area, as one size does not fit all. Our surgeons have excellent experience in various brow lift techniques and can help guide you based on the results you desire.

About Dr. Brent Hayek

Dr. Brent Hayek, plastic surgeonDr. Hayek’s areas of expertise include both reconstructive and cosmetic procedures. He addresses “droopy” (puffy) or malpositioned eyelids, treats Graves disease or thyroid problems as they affect the eyes, and orbital problems including tumors around the eye and fractures that affect the protective bony walls. Dr. Hayek also handles tearing problems that involve obstruction, infection or other issues of the tear drain system.

Dr. Hayek performs a number of eyelid and facial cosmetic services include Botox®, facial fillers and peels, upper and lower blepharoplasty, midface and endoscopic forehead lifts.

Dr. Hayek’s research interests include eyelid and orbital tumors, as well as various implants suitable for long-term eyelid reconstruction. He has published articles in peer-reviewed publications, book chapters and has presented at regional, national and international meetings.