Blepharoplasty and Brow Lift: Advanced Art of Cosmetic Surgery

Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery Richmond, Virginia, USA


	*Facial Rejuvenation Surgery*
	*Blepharoplasty and Brow Lift*

Blepharoplasty and Coronal Brow Lift:

Blepharoplasty or Eyelid Lift is correction of excess fat and drooping skin of the upper eyelids and bulging fat pockets of the lower lids. Frequently, a large component of the apparent skin excess on the upper eyelids is actually the downward movement of the forehead skin causing low positioning of the eyebrows, and sagging of the upper lids, leading to a "tired look". Blepharoplasty (lid lift) can be performed on upper or lower lids, or both. Coronal Brow Lift or Forehead Lift is often recommended to correct the source of much of the excess upper lid skin; i.e. skin which has fallen from the forehead, weighing down the upper lids. Upper or Lower Blepharoplasty will remove excess fat which has protruded from around the eyes, correcting the apparent bulges, but will not correct the fine wrinkles of the lower lids. Lower lid blepharoplasty actually may increase the apparent number of fine wrinkles by deflating the bulging lower lid skin and allowing it to relax. It is not possible to cut out much lower lid skin to "tighten" it, because of the risk of actually pulling the eyelid downward (scleral show and ectropion), and in fact these wrinkles are best remedied by an adjunctive procedure such as skin care products, CO2 Laser Resurfacing, or light chemical peel. Often, at least fifty-percent of the apparent problem with the upper eyelids is due to brow sag or brow ptosis. Correcting this component by a Brow Lift will also allow release of the muscles causing the "frown lines" just above the nose, as well as smoothing of the major transverse wrinkles of the forehead, caused by chronically animating the forehead to raise the brows to fully open the eyes. When skillfully performed, this technique does not cause a "surprised look", but it will nicely refine the appearance of the upper eyelids and orbital skin, which will also ease the application of eye makeup. Before proceeding, it is always important to have a recent thorough eye exam, by an Eye Specialist , to be sure that there is no underlying silent eye disease (e.g. Glaucoma) which could be aggravated by the surgery, and cause complications. Blepharoplasty and Browlift are done under local anesthesia, with sedation, and are often combined with facelift and necklift procedures. These procedures are appropriate for healthy patients in my AAAASF-certified Ambulatory Surgery Center.

Photos Before and After Surgery:

Case 1: A 47 year old patient pre-op for upper and lower Blepharoplasty, and Brow Lift. Note the excess lower lid skin which bulges tightly due to the herniated lower lid fat. Also note the upper lid skin excess and wrinkled forehead muscles helping open the eyes. Initial laser skin resurfacing was declined.			Post- op photos a few months after upper and lower lid Blepharoplasty and Coronal Brow Lift. Note improvement in orbital shape, and reversal of wrinkling of the forehead to open the eyes. Note also the flattening of the lower lid skin, but now the appearance of lower eyelid wrinkles, which formerly were masked by the tight fat-bulging skin. A trans-conjunctival approach was used to remove the fat via incisions on the inside of the lower lids, thus avoiding any lower lid scars.
Photo at left shows result of a secondary CO2 laser skin resurfacing to eliminate the fine wrinkles of the lids which were unmasked by the blepharoplasties. Close-ups are shown at far right More photos of this patient after a subsequent facelift are seen on the Facelift page (see links below)

Serial lateral pre and post-op, then post-laser photos of the 47 year old patient above. Note the change in orbital and lid shape as the skin is raised back onto the brow, and then further tightened by CO2 laser resurfacing, thus removing virtually all of the visible lid and crows' foot wrinkles.

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Case 2: A 47 yr. old woman is shown with the complaint of looking "tired". History revealed a previous four lid blepharoplasty about 10 yrs before. At this point, most of the upper lid problem is due to sagging forehead skin, closing the orbits, and causing the appearance of too much upper lid skin. A repeat blepharoplasty is not be of benefit here since the problem lies not in the eyelids, but in the forehead.			Pre- and post-op photos are compared here showing the benefit obtained by the Brow Lift, opening the eyes widely, and restoring an elegant rested look. This surgery was done in our office OR suite under local anesthesia and sedation.

Pre-op lateral photo showing the heavy crows' foot lines and brow ptosis or sag.			Post-op photo again shows improvement of orbital shape definition. The brow skin is no longer resting on the upper eyelid, and the bony structures are sharply and attractively defined.