When it comes to recommending a brow lift vs an upper blepharoplasty to patients, there are a few tricks the aesthetic surgeon can employ during the patient evaluation process.
“A lot of patients come in with just their [brow] skin hanging, but other patients have their actual eyelid hanging,” says Andrew Miller, M.D., a facial plastic surgeon at Associates in Plastic Surgery in Edison, N.J. “You need to differentiate the two before surgery.”
Patients who need surgical eyelid intervention typically have a tired look from their heavy eyelids, plus their vision may be slightly impaired in the upper outer quadrant. Additionally, “Eyelid skin is often hanging over the lateral aspect of the eye,” Dr. Miller says.
On the other hand, the eyebrow may be falling, which makes the eyelids look heavy. “In reality, it is just the eyebrow that has fallen, for which a brow lift is performed,” Dr. Miller tells The Aesthetic Channel.
In general, the position of the brow should be at or slightly above the bone over the eye. “So if the eyebrow is below that point, then it is normally the brow that needs correcting,” says Dr. Miller, who has been treating eyelids for 18 years.
TIP: If you lift the brow into a more natural position and eyelid heaviness disappears, correction is limited to the brow.
“This difference is easy to detect. However, usually both the eyebrow and eyelid need correcting,” according to Dr. Miller.
Eyelid ptosis can be corrected at the time an upper blepharoplasty is performed. “Ptosis can be slightly harder to detect because sometimes patients come into the office and they do not necessarily look like they have ptosis,” Dr. Miller says. “They are simply lifting up an eyebrow. A lot of patients have asymmetrical rising of their eyebrows or one side rises more than the other.”
TIP: Ptosis can be ascertained by having the patient close his or her eyes and keeping them relaxed.
Upper eyelid surgery takes about an hour, whereby an incision is made in the natural upper eyelid crease and excess skin removed. According to Dr. Miller, he may also remove a thin strip of muscle and some excess fat before closing the incision.
A ptosis repair is performed while the upper eyelid incision is open, followed by the patient in a sitting position to ensure that good correction has been achieved. Ptosis adds about 30 minutes to the blepharoplasty, according to Dr. Miller.
For patients who may need a brow lift in addition to a blepharoplasty, Dr. Miller schedules the brow lift immediately before the eyelid procedure. With small incisions in the forehead (hairline), “The brow skin is elevated and released from the skull,” Dr. Miller says. “The brow skin is then able to be lifted and secured down before the incisions are closed.”
The brow lift adds an additional hour to the other procedures, all of which are outpatient. While Dr. Miller uses general anesthesia for the brow lift, the other two interventions only require local anesthetic.
The average recovery for any of the three procedures is 7 to 10 days, with initial bruising and swelling, and adverse events are rare.
“Patients usually achieve a nice rejuvenative look,” Dr. Miller says. “Most patients are very happy.”
Results can last more than 10 years.
“However, if you just do an upper eyelid skin incision on someone who needs a brow lift, their eyes are not going to ‘pop’ as much,” Dr. Miller says. “The patient needs to be fully evaluated correctly and the proper procedures performed for results that pop.”