- Forehead & Browlift
Q: Asian eyelid surgery, incisional, done 20 yrs ago. Now upper lids sagging, what procedure to fix it and who? Had incisional Asian eyelid surgery for my monolids. My upper lids are sagging esp. outer corners, due to age. I need them fixed. What procedure do I ask for? Do I need a PS who is experienced in Asian eyelid surgery? Can it be done with a facelift, chin implant & lipo, neck lift , temporal browlift like a regular blepharoplasty? Or is it more complex? Thank you for your valued opinion.
A: You need blepharoplasty for the upper lids to remove the excess skin and fat. Look for someone who has expertise performing blepharoplasty on Asian eyes, as this takes extra skill and knowledge. As for the other procedures, they can and should be done on the same day to minimize recovery time. You can be awake for the blepharoplasty and asleep for the facelift with chin augmentation, neck lift, and brow lift. I hope this helps.
Q: Best approach to fix under eye bags and discoloration? I am a 42 year old man, and I’m increasingly frustrated by my very tired-looking eyes. My skin is healthy, and I would otherwise look young for my age. I went for a restalyne consultation, and they recommended 2 vials to camouflage the protruding fat pads. The cost would be $1700, and the fix would obviously be temporary. What would you recommend based on these pictures? Thanks.
A: You’re right; a hyaluronic-acid based dermal filler such as Restylane can fill out your under-eye hollows, but will only be a temporary fix. Lower blepharoplasty with fat repositioning can fill in the hollows, and also remove and tighten excess skin. The rejuvenation will be immediate and permanent. While you will continue to age, as normal, your eyes will continue to look good for up to 10 to 20 years. Find a facial plastic surgeon who specializes in eye rejuvenation to get the permanent improvement you want. I hope this helps.
Q: Thinking to make an operation for my eyes – skin removal. I don’t know what is exactly the name for what I have on my eyes but it is a small skin which is a bit on my eyes , I would like to remove it , is not really nice for my makeup and I don’t understand why it’s there , so what do you think Can I remove it , it is painful, how many days I have to recover and a approximately price? Thank you very much.
A: The procedure that would help you get more definition in the upper eye area is called upper blepharoplasty. It entails removing a bit of the excess fat and skin to create a less “puffy” look. It’s essential, however, that too much fat not be removed, as that could be aging. The scar for the procedure is very small and would be hidden in your eyelid crease. You will have postoperative pain and swelling, but these can be controlled with over-the-counter medications and ice packs. I hope this helps.
Q: Possible to Get Wider or Bigger Eyes? I was born without double eyelids, but they naturally developed as I was growing up. However the size of my double eyelids constantly change (bigger/smaller). My eyes are small and round, but the pink part near my tear ducts are not visible. I learned that there is a type of Asian eye surgery that can make this visible. Will this surgery help? Can my eyes get any bigger or wider? Thank you in advance for all your help!
A: Yes, you can have surgery to alter the epicanthal fold, which is currently making your eyes look hooded and sleepy. Your eyes are already a good size, so they do not actually need to look “bigger,” just more alert. When you consult with a facial plastic surgeon who has expertise in surgically altering Asian eyes, you will get a better idea of what your final results will be. I hope this helps.
Q: Is Minor Ptosis Best Left Alone? I have what are considered “big” double eyelids, unfortunately, I have ptosis in both eyes, a very small amount, about 0.5mm in my right eye (covers A TINY portion of the black pupil) and about 1mm in my left eye (covers also a tiny portion of the black pupil). I don’t know whether to get this corrected or leave it alone; I don’t think my vision is being blocked, but I think I might be straining my eyes at times..isn’t ptosis only a problem if vision is being blocked?
A: If your ptosis is bothering you enough to write a post about it, then I suggest consulting a board-certified facial plastic surgeon who specializes in blepharoplasty to explore your options. Ptosis can be a problem if your vision is blocked and may even qualify as a medical condition that will be covered by your insurance. Even when ptosis is minor, it can be annoying and cause eye strain, as you noted. I hope this helps.
Q: Surgery to Make Non-Asian Eyes Bigger? My eyes are fairly small for my face. I’m wondering if there is surgery that can make them look bigger. I’m not Asian, no anatomical problems, just really small eyes.
A: The real answer to your question can only be determined by an in-person consultation. However, eyes often appear to be small owing to excess skin on the eyelid or a droopy brow. Each of these is easily remedied with either upper blepharoplasty or a brow lift. The goal would be to reveal more of your eye while keeping your expression relaxed and natural. This takes a great deal of skill, so please take your time finding an expert to help you. I hope this helps.
Q: Is 18 Years Old Too Young for Eyelid Surgery?My baby sister is turning 18 in a week and for the past year, she has been saving her money for an upper eyelid surgery. Her upper eyes are and have always been slightly droopy and she constantly looks tired or mad (even when she is not). The skin hits her eyelashes, which sometimes causes a rash on the skin. She is very unhappy. I’m just a little worried and I want to know if 18 years old is too young to have upper eyelid surgery. Also, what are the complications for someone this young? Will it look worse as she ages or will this be good for her? Thank you!
A: Age is not the most important decision for a patient undergoing a blepharoplasty. The Anatomy is more important. If your sister’s eyelids are giving her trouble, she may benefit from upper blepharoplasty, which will remove the excess skin. Blepharoplasty in a young patient should be conservative and retain the fat around the eye. This can be done at any age at which it is needed. Because she’s young with presumably excellent skin tone, she should respond well. I hope this helps.
Q: What Can I Do About a New Fold in my Eyelid? Two weeks ago my left eyelid got an extra crease in it that hasn’t gone away since. Not only does it look extremely strange, it’s very uncomfortable and makes feel heavy to open all the way. Is there anything I can do to make it go back to normal? I’ve been using an eye wrinkle cream that hasn’t seemed to help. It is usually normal for about an hour after I wake up, but once the “morning puffiness” goes away it’s back to an extra eyelid. Any advice would be appreciated!
A: Surgery would be the the most satisfactory and permanent solution for the extra skin in your eyelids. Creams can’t resolve that degree of skin laxity. A ptosis repair and possible upper blepharoplasty would remove the extra skin that’s apparent in both your eyes, plus make them look more symmetrical. I hope this helps.
A: When performing eyelid surgery, a board-certified facial plastic surgeon will make the incision inside the crease of the eyelid and suture underneath the lid, where the stitches cannot be seen. It is also fortunate that the skin on the eyelid is very thin and heals so well that the scars will be virtually invisible. Massaging the scar, once it’s healed, can help break down the collagen and make it blend into surrounding skin faster.
A: I’m sorry that your congenital ptsosis (the medical term for a droopy eyelid) is making you feel self-conscious. Please don’t let this minor problem stop you from looking other people in the eye.
Surgery is the only way to correct the elongation of the levator muscle that causes the drooping. See if your parents are willing to bring you to a facial plastic surgeon for a consultation. If not, after you turn 18, you will be able to have a consultation on your own. Cost will vary by region, practitioner, and what needs to be done to completely rectify the drooping. The important thing is to find a surgeon you trust; a payment plan can be worked out, if necessary. I hope this helps.
A: It sounds like you may need some fat removal and perhaps some excess skin removed as well. You will need to be evaluated in person by a facial plastic surgeon who has expertise in blepharoplasty. This would still be an eyelid lift procedure. I hope this helps.
A: In evaluating patients, anatomy is what matters..not age. While you are young for surgery, it could be an option for you. You could consider a conservative brow lift either surgically or non-surgically as you low eyebrow is contributing to the heaviness of the eye. You could consider non-surgical options such as botox or fillers to help lift the brow. You will need to be evaluated in person by a facial plastic surgeon who specializes in eyelid surgery. I hope this helps.
Q: I’m 22 years old and I really despise my sagging, hooded eyelids. I love makeup but I am unable to do many makeup looks (winged eyeliner and eyeshadow) because as soon as I rest my eyes it is covered up. I’m not sure whether I should get a blepharoplasty or forehead lift or both.
A: From your description and photos, you would probably benefit most from a brow lift, which would increase the space between your brows and lids and eliminate the sagging that is making you look much older than your 22 years. At our center, we offer a “one-centimeter brow lift,” which is a minimally invasive procedure that lifts the lateral brow (closest to the temples). If this is not sufficient to resolve your issue, then an endoscopic brow lift would be performed instead. Your in-person consultation will give you the answers you need. I hope this helps.
A: The brow lift surgery has evolved overtime. The “old school” goal of a browlift was to raise the brow as high as possible without consideration of how the appearance would fit with the other facial features. This type of browlift was overly aggressive and generally fallen out of favor of most reputable facial plastic surgeons. This overly aggressive brow lift is called a coronal brow lift. This type of brow lift should be reserved for patients with severe drooping of the brows.
The aesthetic procedures and goals of a browlift are different today. A properly placed brow should have a gentle arch that is just above the brow bone. This can be effectively created by minimally invasive browlifts such as an endoscopic browlift or a 1cm browlift that I perform.
I agree that the brows should be conservatively lifted during a brow lift procedure. I hope this helps
A: You choose whether to be awake or asleep for eyelid surgery. I usually perform blepharoplasty using local anesthesia and an oral medications to relax patients. General anesthesia is still an option, though it may prolong the recovery time. Blepharoplasty helps rejuvenate your look by lifting and tightening lids and repositioning fat. You should look better rested and more alert, but natural. I hope this helps.
Q:When is blepharoplasty considered to be medically necessary? The skin on my upper eyelids hangs down over my eyelashes. It tends to push my eyelashes into my eyes and makes it hard for me to use my computer without tilting my head back. My eyes also get tired and my vision blurs towards the end of the day. I would like to get this fixed, but I am not sure if insurance typically covers this sort of thing.
A: From your description, it may be that your drooping upper lids are causing problems with your vision and this may be considered a medical condition that could be covered by insurance. Your first step is to be evaluated by an ophthalmologist, who will administer a visual field test. Even if the surgery is not deemed medically necessary, I highly recommend your consulting with a facial plastic surgeon because at minimum the drooping lids are causing you fatigue and distress, and should be remedied. I hope this helps.
Q: I’m considering blepharoplasty for upper and lower eyelids, and I’ve been looking at before and after pictures — and I like what I’ve seen. However, I’m wary of looking at just the best results. How many is a good number for a surgeon’s portfolio and can I expect to see photos of eyelid surgery scars?
A: Looking at before-and-after photos on the websites of facial plastic surgeons is only a first step in the research you need to do to find the best person to perform your blepharoplasty. Look into their credentials. Meet and interview several physicians in person. Look at the patient photos they keep in the office. Ask to speak to previous patients. Do not stop until you have found a facial plastic surgeon whom you trust and whose work is up to the standards you wish to achieve with your own procedure. I hope this helps.
A: Other people read us through our eyes. Drooping lids, heavy brows and deep under-eye troughs not only make us look older, but may give the impression that we lack energy. The hyaluronic-acid dermal fillers offer only a temporary solution, must be re-administered every six to twelve months, and can cause complications. Upper and/or lower blepharoplasty can take years off your look and last for up to 10 years. I hope this helps.
Q: Can I get upper blepharoplasty at 19 years old?
A: Your drooping eyelid, otherwise known as ptosis, is caused by a weakened Müeller muscle in your upper lid. It is not uncommon for this condition to worsen with age, as you have noticed. I would treat your ptosis by lifting the lid at the point where it crosses the iris. You are not too young for such a procedure. I hope you find someone who will help you.
Q: Is muscle around eyes excised during blepharoplasty?
A: I spare the eye muscles rather than excise them during blepharoplasty, but this depends on patient anatomy and need. Sometimes the muscles have grown so lax that they drag the eyelid downward. Minimal excision and/or tightening may help. It’s a minimally invasive surgery and recovery time tends to be quick, with return to normal activities within a few days. I hope this helps.
Q: When I smile my eyelids look swollen & I have eye bags under eyes. How do I treat this?
A: While I would need to see you in person to evaluate your situation, bags under the eyes are generally caused by pockets of fat. These can be moved into a better location during lower blepharoplasty. If there is excess skin present, that can be removed during the same procedure. The heaviness in your upper lids could be caused by a number of factors, but might be resolved by upper blepharoplasty, which would open the eyes. I hope this helps.
Q: What causes droopy lids and brows, and is upper bleph the right choice for me? I have droopy brows and eyelids. I’m interested in upper bleph/botox. Is this the same as dbl eyelid surgery, with the same risks? What are the risks down the line for upper blepharosty for the functioning of my eyelids (blinking/closing) &dryness? How can I tell if eyelid surgery alone will meet my needs? Can botox for the brow suffice?
A: You can answer your last question by getting a Botox lift and seeing if it opens your eyes sufficiently. From your description, however, it sounds like you might benefit from blepharoplasty and possibly a slight brow lift. The risk for adverse outcomes such as dysfunctional eyelids and dryness can be minimized by finding a facial plastic surgeon who has expertise treating the eyes. You need to be evaluated in person. I hope this helps.
A: If you want a more wide-eyed look, it is achievable with blepharoplasty. Please find a facial plastic surgeon with expertise in treating Asian eyes. I hope this helps.
Q: Bromelain And/or Arnica Before Surgery? I’m having revision lower blepharoplasty next month. I had bruising for 6 weeks after the first surgery. Do you recommend Bromelain and/or Arnica before surgery as well as after? My Dr. seemed somewhat indifferent to there use. If I do take these herbs, how much and when should I start taking it? I really don’t want to be in hiding for another six weeks!
A: While preparing for surgery, I do recommend that patients begin taking the herbal supplements Arnica Forte and Bromelin at least two weeks beforehand. These herbs can help prevent excessive swelling and bruising after surgery. I also recommend discontinuing blood-thinning agents, such as aspirin, alcohol, fish oil and multivitamins, for at least two weeks before the surgery and several weeks afterward. I hope this helps.
Q: Will my Insurance Pay for Blepharoplasty? Insurance covers for eyelid surgery?
A: You will have to check with your carrier to get an answer to this question, but generally insurance does not cover plastic surgery unless it is performed for medical reasons. In the case of blepharoplasty, some patients experience such significant drooping of their upper eyelid that it actually impairs their vision. As mentioned by my colleagues above, an optometrist would need to evaluate your case and you may need to provide additional proof of medical need to your insurer before you can be cleared. I hope this helps.
Q: How Can I Fix One Drooping Eye?
My eyes weren’t always uneven. I did something stupid 6 yrs ago and wore one contact on my right eye for a couple of months. My left eyelid drooped, and my left eye looked smaller than my right eye. Is there anything I can do to make my eyes even again? Brow lift? Laser blepharoplasty?
A: First, I encourage you to stop blaming yourself for your drooping left eyelid. It is unlikely that wearing a contact lens in only one eye contributed to this condition. Drooping eyelids are caused by the loss of collagen in the skin and an atrophying of the underlying muscle that comes with age and sun damage It can be exacerbated by the sagging of forehead muscles, which lowers the brow skin.
You are correct to think that blepharoplasty, ptosis repair, or a brow lift could help rectify the situation and give you a more open, brighter look. Which treatment would be best for you would depend on an individual consultation with a board-certified facial plastic surgeon who will evaluate your entire facial anatomy, not just the drooping eyelid.
Q: Browlift Vs Blepharoplasty – Which is Best for Sagging Eyelids? Is a brow lift (forehead lift) better to raise sagging eyelids than a blepharoplasty?
A: Both browlifts and blepharoplasty can help “open up” sagging eyes, making you look vital, youthful, awake and happy. The two procedures can also be used together for optimal results. Which approach is best for you can only be determined by a consultation with an board-certified facial plastic surgeon with training and experience in oculoplasty (eye plastic surgery). He or she will evaluate your bone structure, skin tone and muscle tone to determine how to give you the best results possible.
Q: My eyes are small with dark circles, can I increase the size naturally, without surgery?
A: Without seeing a photo or being able to evaluate you in person, it is impossible to say what kind of treatment would be best for you. In general, there are no “natural” treatments that will make the eyes appear larger. There are surgeries that can be done to help brighten the eye area and create a wider, more youthful appearance; you would have to see a plastic surgeon to see if you are an appropriate candidate for one of these surgeons. There are various ways that dark circles can be treated as well, depending on the root cause of the circles. Please see a board-certified facial plastic surgeon for a consultation to find a good treatment plan for you. I hope this helps.
Q: I’m at 3 months post eyelid surgery, and my eyelids are still red. I apply a scar ointment every day and night but haven’t seen any improvement. Am I just healing slowly or should I be concerned?
A: While normally I see patients’ eyelid scars fade well before 3 months, each individual is different and it is possible that you’re simply healing slower than normal. In addition, you mention using a scar ointment day and night. It’s possible that the scar ointment is causing irritation which is interfering with your healing. Try stopping use of the ointment for a while and see if that helps any. If it does not, visit your surgeon again once he’s back in the country for a follow-up visit. I hope this helps.
Q: Would most insurances cover an eyelid lift due to health concerns? My eyelid has gotten so saggy that I can see it dropping in my eye.
A: Most insurance providers will only cover an eyelid lift if there is medical documentation that vision is impaired due to the drooping eyelid. You would have to see an ophthalmologist and have them perform vision tests on you, which you could then take to a plastic surgeon and see if insurance will accept your case. I hope this helps.
Q: What is an eye tuck?
An eye tuck or blepharoplasty will work to tighten the eye area, but will not affect the rest of your face. In upper blepharoplasty, the excess skin that causes drooping eyelids is removed. The muscle may be excised or tightened. You may require some fat removal, though from your photos it looks like you would not need it. The incision is made in the eyelid crease to hide the scar. The lower lids can also be treated, with excess skin being removed, fat repositioned to fill out hollows, and the muscles tightened.The end result is smoother skin around the eyes and a rested, rejuvenated, natural appearance. I hope this helps.
Forehead & Browlift FAQ
Q: Possible to Get a Natural Looking Brow Lift? I am considering having a brow lift and was wondering what the chances of looking like my eyes are always “wide open” are going to be? I’ve looked in so many magazines where the stars have had this done and they look like they cant close their eyes…do all brow lifts make you look that way?
A: Celebrities often are the worst examples of facial plastic surgery, possibly because relying on their faces for a living makes them seek more treatment than they actually need. A well-performed brow lift should look natural and relaxed. You should look more rested and alert, but not surprised or alarmed. Please take your time to find someone who is truly expert in rejuvenating the forehead and brow while maintaining a patient’s natural range of expressiveness. I hope this helps.
Q: How Long Do Brow Lift Results Last? I am 58 years old and have much sagging in upper eyelids. I went to see an ophthalmologist who performed one of the first eyebrow lifts in San Jose. He recommends I wait another year or two for best results. Says the lift only lasts 5 years. Is this true? How long do brow lift results last? Should I wait?
A: There are different types of brow lifts, which may affect your results. And while every patient is different, most brow lifts will last about 10 years. You will continue to age during that time, of course, which means your brows will probably droop again. At that time, you can elect to get another lift. Delaying a brow lift means that you will continue to age without remedy. Get a brow lift now and you’ve turned back the clock at least five to 10 years and will keep those good results for anther 5 to 10 years or more. I hope this helps.
Q: Brow Lift for 24 year old female: Too Early? I am a 24 year old female. I have very droopy eyebrows. Is it too early to get a browlift??
A: Need, not chronological age, determines when and if you should have cosmetic surgery. If at age 24 your eyebrows are already drooping, they are probably dramatically aging your face and will only worsen over time. There are several options for a brow lift:
- One-centimeter-incision brow lift – A minimally invasive lift for early aging. This would probably be best in your case, though I would have to see you in person to verify.
- Endoscopic brow lift – The entire brow is lifted for a more dramatic rejuvenation. Your hairline may also be lifted slightly.
- Direct brow lift – This is usually done only in instances when the sagging brow limits vision.
- Coronal brow lift – Only used in cases of extreme sagging.
Your first step is to find a board-certified facial plastic surgeon who can evaluate your brow droop and recommend the best corrective measure. I hope this helps.
Q: What is an endoscopic brow lift and how does it differ from a traditional brow lift or forehead lift?
A: An endoscopic brow lift has become the surgery of choice over the past decade for people wanting a robust lift with less scarring than older types of brow lift surgery. The coronal brow lift is what I suspect you are referring to in terms of a “traditional” brow lift. Coronal brow lift surgery is the most invasive, requiring an incision across the scalp from ear to ear and a strip of tissue to be removed. In contrast, an endoscopic brow lift requires only a few incisions placed in the hairline, from which the forehead skin and eyebrows are elevated. I also perform a “one centimeter incision brow lift” at my practice for people who need only a small, subtle lift. As inferred from the name, this type of surgery requires only a one-centimeter incision placed in the upper eyebrow hairs, which is closed carefully so that the scar is as minimal as possible. Which type of brow lift is best for you will depend on your individual anatomy, extent of eyebrow drooping, and recovery tolerance. I hope this helps.
Q: What Would A Brow Lift Do For Your Forehead?
A: If you lift your brow slightly up and toward the sides, you can get a good idea of what a brow lift would do for you. The change should be subtle, but give you a smoother and more rested look, without creating an “alarmed” expression. I hope this helps.
Q: I’m young, 20, but my eyebrows really bother me. They are pretty much straight across. They have no arch. My question is, is there any way to get the arch? Brow lift? Botox? Eyelid surgery? What will help me? I look so much better when I raise my forehead.
A: Given your youth, you may want to try Botox first to give your eyebrows a little more arch and shape. If you like the look, I’d recommend proceeding with an eyebrow lift, which will last longer and ultimately cost less, as Botox must be re-injected every three to four months to maintain results.
Q: What’s the difference between a forehead lift and a brow lift? Are they the same procedure?
A: There are many different names for surgical procedures depending on the surgeon. For some surgeons, a brow lift and a forehead lift may encompass different procedures. Personally, at my office, a forehead lift and a brow lift are two different names for the same procedure. This procedure elevates a saggy brow line and eliminates frown lines in between the brows. I offer four different types of forehead/brow lifts:
- 1-centimeter incision brow lift, which is the most minimally invasive procedure with the easiest recovery. As the name implies, a one-centimeter incision is made in the eyebrow, through which a special suture is made that lifts the skin, muscle, and fat.
- Endoscopic brow lift, which is used when patients require more of a lift than the one-centimeter lift can provide. Only a few incisions are necessary, and recovery time is slightly longer but results are more dramatic.
- Direct brow lift, which is only used in rare cases where the brow has dropped so much that vision is impaired. The tissue just above the brow is raised in this surgery.
- Coronal brow lift, which is an older technique rarely used today due to its invasive nature and large scar. A coronal brow lift requires an incision all the way across the top of the forehead from ear to ear, from which a strip of tissue is removed in order to elevate the brow.
Talk to your surgeon to find out what a forehead or brow lift entails in their practice, and always be sure to see a reputable, board-certified facial plastic surgeon. I hope this helps.
Q: I had a brow lift, but I still have prominent frown lines. What can I do to fix this?
A: For deep frown lines between the brows, Botox and possibly filler as well are the best options. Botox relaxes the muscles that cause the lines to appear in the first place, and if the lines are too deep to be fully resolved by Botox, a dermal filler such as Juvederm or Restylane can be used carefully to fill the remaining depression and smooth the lines out. Filler in this area does have risks and I typically will not fill in the frown lines between the eyes It’s important to see a highly skilled practitioner for filler between the brows, however, as proper placement is extremely important in this area. I hope this helps.
Q: I want my eyebrows to be significantly higher. Can this be achieved non-surgically or do I need a brow lift?
A: For a significant lift, surgery is the only option. However, for many people, especially those on the younger side, a small lift is all that’s needed to brighten the eye area. This small lift can be achieved through Botox, and will last approximately 3 to 4 months. Please see a board-certified facial plastic surgeon who can walk you through your options and help you to decide the best course of action. I hope this helps.