Posts Tagged ‘brow lift’

Your Age Defying Questions Answered: Secrets to Defying the Aging Process

facial-rejuvenation-emailAging is a part of life. And yes, your appearance will change as you get older. But that doesn’t have to be a bad thing. Aging gracefully is about allowing the best version of yourself to shine through, and there are countless facial rejuvenation tools and treatments to help you do just that.

During our live chat on Tuesday, July 19th, Emory Aesthetic Center plastic surgeon, Dr. Felmont Eaves, answered all of your questions about helping to defy the aging process. Dr. Eaves discussed everything from skin care products to injectable treatments to cosmetic surgical options, such as Botox®, facelifts and eyelid lifts.

Below are just a few questions we were unable to respond to due to the large number of questions we received. For a full listing of questions and answers, please read our chat transcript. It is full of useful tips and answers that may be relevant to you. You may also visit emoryaesthetic.org for a full list of services and treatments offered by the Emory Aesthetic Center.

Question: How do I minimize dark circles beyond getting more sleep?

Dr. Eaves: There are two reasons that we may develop dark circles under the eyes. The first reason is that there is a dark tone to the skin itself. That is a difficult problem to treat, as currently we don’t have a great solution to dark circles. Sometimes bleaching creams containing hydroquinone can help, but that isn’t always successful. And chemical peels typically don’t work in this situation.

The other reason for dark circles, however, is the shadowing caused by bulging fat pads of the lower lids. Either surgery to remove or reposition the lower lid fat, or an injection of filler into the depressed area underneath the prominent fat – can soften or eliminate that shadow.

Question: What’s the best way to help with my lower face sagging without injecting a bunch of fillers?

Dr. Eaves: In the right patient, fillers can be great, but when the face truly begins sagging (not just deep folds by the mouth), then surgery is required to make truly significant changes. With a lower face lift (which typically includes tightening the neck as well) the jowls can be reduced, the cheek contours can be improved, and deeper folds/wrinkles around the mouth can be softened. It can provide dramatic, long lasting results, and recovery is generally relatively quick.

Question: How can you stop sagging eyelids?

Dr. Eaves: Sagging eyelids are generally treated with a blepharoplasty (an eyelid tuck and eyelid lift). Blepharoplasty can be used to treat the upper eyelids, the lower eyelids, or both, and are often combined with other areas of facial rejuvenation, such as a facelift, neck lift, and brow lift. Sometimes a sagging upper eyelid also has a component of malposition, where it isn’t just saggy skin. In those cases the lid can be repositioned while the blepharoplasty is being done.

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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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.