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.
A woman in her later 50’s who has some obstruction of her upper vision by excess upper eyelid skin and brow ptosis (age-related drooping of the eyebrows)
She is shown before and again 3 ½ months after bilateral upper eyelid blepharoplasty combined with browpexy. With a brow “pexy,” the eyebrow are fixed to the orbital septum so they don’t drop further when the patient stands up. . They are not elevated as in a brow lift but it is a simpler procedure that some patients prefer.
A woman in her mid 60’s who is bothered by an aged appearance of her forehead and eyes. She is shown before and again, 7 weeks after a coronal brow lift and a bilateral upper eyelid blepharoplasty. When the brows have descended and there is heaviness of the skin in the lateral brow area, this cannot be corrected with a blepharoplasty alone
A woman in her early 60’s who is bothered by a tired appearance. She does not like the hooded appearance of her eyes and upper face. On questioning she has problems with chronic headaches which may be related to chronic strain of the forehead muscles working to hold the eyebrows up. As we age we lose volume in the face which leads to dropping of the eyebrows. She has had lower eyelid blepharoplasty elsewhere nearly 20 years ago.
She is shown before and again, 6 weeks after bilateral upper eyelid blepharoplasty and a coronal brow lift. A brow lift is a “face lift” of the upper face with the incisions hidden in the hairline. The forehead lines diminish because she is no longer working to hold her brows up with the muscles. The brows have been lifted to a natural level and she no longer has a tired appearance.
A woman in her late 50’s who is bothered by drooping of her eyebrows and an aged appearance of her eyes. She has prominent “tear trough” deformities and under eye “bags”.
She is shown before and again, 4 ½ months after an open brow lift, upper lid blepharoplasty and lower eyelid blepharoplasty with fat pad transposition into the tear trough area. She holds her left brow slightly lower before and after her surgery. She is thrilled with the more youthful but still natural appearance after surgery.
Not a brow lift, but the use of the endoscopic approach that we use for an endoscopic brow lift to remove a submuscular lipoma of the forehead in a young woman in her early 20’s. The typical approach is to make an incision if a forehead crease, but she does not have a forehead crease to help camouflage a scar of this type. So the lipoma ( a benign tumor composed of fatty tissue) was removed through two small incisions in the scalp using the endoscope. She is shown just before and again, 6 weeks after surgery.
A woman in her early 60’s who is having difficulty with her vision at night because her upper eyelids and brows are blocking her vision. As we age we “deflate” and the brows and eyelids come down. She is shown before and again, 6 weeks after an endoscopic brow lift, combined with upper lid blepharoplasty. At first glance it may not appear that her brows are elevated. But the brows are penciled in and a mole on her left temple is shown to be pulled up from the brow lift. A blepharoplasty alone would not have appeared as natural because it would not address the drooping of her eyebrows. Her visual obstruction is corrected and she looks more rested as well.
A woman in her early 60’s with obstruction of her vision from brow ptosis and eyelid skin hanging down. She is shown before and again, 6 week after an endoscopic brow lift and bilateral upper eyelid blepharoplasty. She has a refreshed look after surgery.
A woman in her mid to late 60’s who is bothered by an aged appearance. She is shown before and again, 5 months after an endoscopic brow lift, upper eyelid blepharoplasty, fat grafting to the cheeks and lips, Facelift with lateral Smasectomy and peri-oral dermabrasion. Her results will be limited somewhat because of decreased skin elasticity- the “fabric” that we are working with. Nonetheless, she has a dramatic and natural appearing improvement at 5 months. Skin quality is somewhat better with the fat grafting. The dermabrasion is a tried and true technique that can give improvement of the lines around the mouth but with less risk of bleaching that can be seen with laser or deep chemical peels.