Brow Lift How I like to do it.

If it appears your eyes are drooping, feel heavy and you see puffiness, bags or looseness in the skin around the eyes, your probably ready for a brow lift and/or eyelid surgery. 

Let's  first understand the characteristics of the eye most of us find pleasing.  In a female the eyebrow should be high and arching.  There are many different shaped eyebrows, but most commonly the highest point of  the brow begins directly in line with the outside edge of the iris.  However, it may begin just outside that point also. 

The upper eyelid should show a nice deep crease.  This can vary, but is usually  about 1 centimeter in depth.  The lower eyelids should be free of bags, loose skin and should tilt upwards as the lid moves towards the outside edge.

When I am evaluating your eyes I will look for lateral (outside) hooding.  Lateral hooding is due to ptosis (sagging) of the brow.  It causes a flattening and loss of the high arch and sometimes a loss in a visible eyelid crease on the outer part of the  eyes. 

In many cases the inner portion of the eyelid crease can still be seen.  This hooding or curtain of skin may actually cause inability to view objects when gazing upward and outward. 

When your eyebrow  becomes heavy and lateral hooding exists, you will see that you deepen the forehead lines by continuously raising your eyebrows to see better. 

Because ptosis (drooping) of the eyebrow is so common, it is essential to  determine if lateral hooding exists. 

If the ptosis exists, then upper eyelid surgery should not be done without a brow lift, otherwise, the surgical results will be compromised, and minimal change may occur.   Unfortunately, this is the most common mistake made by those performing eyelid surgery.  This results in further lowering of the eyebrow from the pre surgical position, a less visible eyelid crease and early  recurrence of the original problem.

Upper eyelid surgery by itself should be preserved for those who have a good eyebrow arch and no lateral hooding.

The Brow Lift is an excellent procedure to achieve a more  youthful appearance in your eye area.  It has very little postoperative pain associated with it and a quick recovery time. 

The Endoscopic Brow Lift, is my favorite technique, because it requires no  removal of hair or skin and maintains the hairline at a similar level. 

Through a few small incisions hidden in the hair, an endoscope (similar to an arthroscope used by the orthopedic surgeons) is passed under the skin and  the eyebrow attachments are repositioned higher. 

This new position is maintained for several days with sutures and bandages.  Most of the time it is also necessary to remove excess upper eyelid skin, hiding  this incision along the eyelid fold. 

The endoscope can also be used to correct frown lines between the eyes and unlike BOTOX , is permanent.

Another type of Brow Lift, the Coronal Brow Lift is performed by making a longer single  incision in the scalp.  Because this incision is more likely to be seen and will raise the hairline, I will reserve this type of brow lift for those with thick enough hair to hide the incision and a low hairline  that would look better in a higher position. 

This second type of Brow Lift is also used when it is necessary to remove deep forehead wrinkles.

Lower eyelid surgery is performed to tighten up the loose skin and  remove the bags under the eyes.  There are two types of incisions.  The most common is an just under the lashes of the eyelid. The three fat pads in the lower eyelid are usually repositioned or removed and the eyelid skin pulled  upward and tightened. 

A second type of incision is on the inside of the eyelid on the conjunctiva.  This transconjunctival incision removes no skin and addresses only the bulging fat pads. 

Since there is no removal of skin, the procedure is best done if you are in your late 20's or 30's or in combination with a laser to help tighten any loose eyelid skin if present. 

If a laser is being used, caution must be taken not to apply the laser energy to the wrong skin  types, which might result in permanent color changes to the skin.

Facts about the Brow Lift Procedure

• Elevates the brow into a most pleasing position

• Less eyelid skin will need to be removed

• Surgical time 1-2 hours

• Usually lasts 8-12 years, depending on the skin texture and tone

• Anesthesia: General or IV sedation

• Swelling and bruising lasts for a few weeks

• Full recovery without limitations is 3-4 weeks

FACTS ABOUT EYELID SURGERY

• Removes excessive skin deepening the upper eyelid fold

• Removes bags under the eyes and puffiness in the upper eyelids

• Surgical time for all four eyelids is around 1 to 2 hours

• Bruising is worse in the lower eyelids and usually lasts 2 weeks

• Full recovery without limitations is 2-3 weeks

Above Photos: Endoscopic Brow Lift- Lifting the corner of the eye to expose more eyelid

Thousand Oaks Endoscopic Brow Lift Coronal Brow Lift -Forehead Lift is performed by Thousand Oaks Cosmetic and Plastic Surgeon Chris Costanzo MD. Thousand Oaks, Beverly Hills, Los Angeles, Calabasas, Ventura, Camarillo and other areas like Encino, Sherman Oaks, Chatsworth, Woodland Hills, West Hills, Agoura, Westlake Village, Moorpark, Oxnard, Simi Valley, Santa Barbara, Los Angeles County, Ventura County, Santa Barbara County and Southern California.

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Disclaimer - The information about Brow Lift surgery contained in this web site is for informational purposes only and does not constitute medical advice. Call to schedule an appointment with Los Angeles area Brow Lift surgeon Dr Costanzo