A woman in her later 60s was shown before and again, 5 months after an anterior hairline brow lift, upper and lower eyelid blepharoplasty, and fat grafting to the mid-face.
Discussion: She has significant brow ptosis but a high forehead. If a traditional brow lift had been performed it would have pulled her hairline back and appeared even more unnatural. Instead, an anterior hairline or “pretrichial” incision is used. It is actually beveled and made in a wavy fashion so that the hairs grow up through the incision and help to camouflage it. This actually lowers the hairline, making it more aesthetic and at the same time, it eliminates the heaviness of the eyebrows and smooths the forehead lines that are more prominent as the patient constantly activates the frontalis muscle to hold the brows up.
Some excess skin is taken out of the upper eyelids at the same time( upper eyelid blepharoplasty). Blepharoplasty of the upper lid alone would not have looked as natural because it would not address the heaviness of the eyebrows from aging ( “brow ptosis”)
The lower eyelids can be the most challenging because she has a combination of prominent fat pads which were reduced here through the eyelid (transconjunctival approach”) but then just a small pinch of skin was excised to avoid pulling the lower eyelids down, and the volume loss from aging that gave a hollow look was corrected with fat grafting. The combined result gives her a rested and refreshed but natural appearance.
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