When we visit the dentist and are told we should always brush and floss our teeth, we usually take the dentist’s advice, even though we don’t always like it. And when our car mechanic says we shouldn’t change the oil without also changing the oil filter, we understand that those two actions are both related and necessary even though doing both is more expensive than doing just one.
We tell ourselves, “It’s just the way it is, and it has to be done.” We pay the higher price because we know it’s important for the health and longevity of our cars. Similarly, in the world of facial aesthetics and droopy eyelid surgery, patients sometimes face a similar set of circumstances, although they may not realize it. The aesthetics of the eyelids and the brow are inseparable.
Your Eyelids and Brows: Understanding the Connection
Many patients ask me to help them with the extra skin and heaviness of their upper eyelids. In almost all cases, those patients also need some modification of their brows. Why? Because the eyelid skin and the brow position are anatomically and functionally related and totally inseparable. They are one anatomic and aesthetic unit; in almost every case, they must be treated together with upper eyelid surgery and a brow lift.
As time goes on, the skin of the upper eyelid becomes thin, loose and redundant. It can sag and even rest on the eyelashes. In severe cases, the eyelid skin can even hang over the eyelashes and obstruct vision. These changes are what prompt patients to see me asking for eyelid surgery. But the eyelids are not the only areas around the eye that droop, sag, and contribute to a tired and aged appearance. The brows are involved as well.
The Impact of Drooping Eyelids on Your Appearance and Vision
The skin around the temple, hair-bearing eyebrows, and forehead can all loosen and sag, contributing to an aged appearance. Most of us compensate by engaging the frontalis muscles of the forehead to actively hold up our eyebrows all day, every day. In the short term, this holding up of the brow can improve the overall appearance of the eyelids, but it is tiring and creates creases and wrinkles in the brow.
Can BOTOX Help the Resulting Wrinkled Brow?
Sometimes, when patients and inexperienced aesthetic providers look at wrinkled brows, they think neuromodulators like BOTOX COSMETIC®, Dysport Aesthetic®, or Xeomin Cosmetic® might be the solution to those forehead wrinkles. When that solution is applied on its own, it relaxes the muscles of the brow, causing the brow to drop even more, making people look even more aged and tired, and making the eyelid skin look even looser and floppier.
Why Simply Removing Eyelid Skin Isn’t Enough
Here’s the real problem, though. Patients who don’t understand the importance of the brow and have a little bit of skin excess on the eyelids often ask me to simply fix their eyelids. They think that removing the excess eyelid skin will help. The truth is that it is a very rare occasion when a patient can actually have a nice outcome by addressing only the skin of the eyelids. In just about every case, something must be done to the brow as well. (Learn more about a temporal brow adjustment.)
What’s the problem with just doing my eyelids alone?
The problem is that if I remove skin only from the eyelids, the brow muscles will lose their stimulus to contract to raise the brow. The brow will then fall even more, resulting not only in an aesthetically displeasing brow position but also undoing any of the benefits of the skin removal from the eyelids.
In these very common situations, removing skin from the eyelid alone is a complete waste of an operation and a complete waste of money.
A Comprehensive Solution: Upper Eyelid Surgery and Brow Lift Together
So, what’s the right thing to do? In almost every case, a combination of a subtle readjustment of the forehead, brow, eyelid and temple areas should be done at the same time as the removal of excess eyelid skin. Traditionally, we’ve approached these areas as two distinct operations: A blepharoplasty (eyelids) and a brow lift. But I, and most modern, forward-thinking plastic surgeons, no longer think of it that way. This procedure is really one operation that takes place at two related sites.
Achieving Optimal Results
We don’t cut the grass without raking the clippings. We don’t put a shoe on our right foot without putting one on our left foot as well. There’s just no way to make the upper third of the face look right without addressing both the upper eyelids and the brow together. That’s just the way it is.
If you’d like to talk with me about your drooping eyelids or other aesthetic concerns, give my office a call at (519) 746-1132 or use the online form to request a consultation. I’ll be happy to examine your eyelids and brows to determine the best treatment plan for you.
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