Browlift

Perhaps the most complicated aesthetic relationship of the aging upper face is that between the upper eyelids and the position of the eyebrows. When evaluating their tired or angry appearance, patients often tend to fail to make this distinction. It’s important since there are two very different operations to treat this problem.

Treating drooping eyelids is performed by removing the excess fat and skin from the upper eyelid. A problem arises when you realize that a portion of the excess eyelid skin is due to the drooping of the forehead and therefore the eyebrows. The lowering of the eyebrow arises from gravity and the downward pull of the frowning muscles between the eyebrows. These are the same muscles that transmit anger when contracted.

How can you tell the difference? If your eyes look tired or your continence suggests anger when you’re not, take a moment and look into a mirror. Relax your forehead muscle so that the transverse wrinkles soften. Make a mental note where your eyebrows rest in repose and the amount of excess eyelid skin that sits above your eyelashes. Now raise your eyebrows 1/2 to 3/4 of an inch while looking at your upper eyelids. If you notice less excess eyelid skin while seeing your eyebrows in a more pleasing position, you probably have significant eyebrow drooping. This often is particularly evident at the outer part of the eyelids where the drooping brow may form hoods over the eyelid. If you saw no change, the excess skin is due to the eyelids only and can be treated with eyelid surgery only.

So what are the options for treating a drooping eyebrow? There are two basic options: either an open or an endoscopic browlift. An open browlift is the traditional approach where an incision is made within the scalp, the eyebrow is raised, and the excess skin is removed within the scalp to hide the incision. Using an endoscopic approach, several small incisions are used to raise the eyebrows. Both procedures can remove the frown muscles between the eyebrows. I tend to use the traditional approach for more severe forms while I use the endoscopic approach for more mild amounts of drooping eyebrows. Eyebrow and eyelid lifts are often performed together as the two procedures are complimentary. The end result is a younger, more rested, and less angry appearance without the surprised look when the procedures are over done.

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