Browlift, Upper Blepharoplasty, Upper Eyelid Ptosis Repair | Montgomery AL

The forehead/brow/upper eyelid complex is a unique anatomical region humans use to express a vast array of emotions. This constant movement of the underlying muscles creates unwanted changes such as lines, wrinkles, and sagging of these tissues. Sun damage changes the quality and elasticity of the skin. Gravitational changes contribute to brow ptosis or drooping of the upper eyelids. Below is a discussion of each of these areas, however when being evaluated and subsequently surgically treated these three areas need to be considered as each effects the other.

Forehead/Brow

The forehead or portion of the face between the hairline and eyebrows is particularly vulnerable to changes with aging.  The forehead frequently lengthens and forms rhytids or wrinkles. The brow loses volume and drops more so in the lateral portion. This leads to excess skin over the eyelid.  If one looks at a picture of themselves from 10-15 years prior these changes become particularly evident.

A browlift/forehead lift is an ambiguous term to describe surgically lifting and rejuvenating the brow forehead complex. At Alabama Surgical Arts Dr. Nizam accomplishes this through 3 methods, each of which are tailored to your personal needs. The procedure is typically performed under general anesthesia and takes approximately 1- 1.5 hours depending on procedure.

 Tricophytic Brow Lift

This browlift/forehead lift uses an irregular beveled incision hidden along the superior hairline. Over the course of 6 months hair grows back through the incision line and camouflages the incision. Of all the brow/forehead lift options it provides the most powerful and long-lasting rejuvenation. During the procedure the skin is separated from the underlying muscle, which also separates deep lines and wrinkles flattening them. Think of this as “facelift” for the brow and forehead as skin is actually being cut out. As a result the procedure shortens the forehead for patients with long foreheads. Ideal candidates:

1. Significant brow ptosis (sagging)
2. Significant sun damage
3. Deep lines in the forehead
4. Long foreheads
5. Stable hairline

 Minimal Incision Brow/forehead lift

This browlift/forehead lift uses 4 small incision placed behind the hairline. It raises the forehead and brows in a deeper plane of dissection below the muscle. No skin is removed and the forehead and brow are shifted or glided along the skull.  It is the second most powerful technique utilized. Since the incisions are behind the hairline they are essentially hidden throughout the healing process. This procedure also lengthens the forehead to some extent. Ideal candidates include:

1. Moderate brow ptosis (sagging)
2. Moderate to minimal sun damage
3. Short forehead
4. Unstable hairline

 Lateral Brow lift

The Lateral browlift is a minimally invasive browlift created to address sagging off the lateral brow tissue. It utilizes a similar plane of dissection as the minimal incision brow/forehead lift however uses only 2 of the 4 incisions. This provides access to the lateral aspect of the brow.  Ideal candidates include:

1. Lateral Brow ptosis (sagging)
2. Lateral hooding (excess tissue over the lateral aspect of the eyelid)

Upper Eyelid

The upper eyelid and particularly upper eyelid skin is typically why most people seek treatment for this region. As discussed prior the forehead and brow position play a large role in the amount of skin over the eye. Below are two procedures used to remove skin from the upper eyelid (upper blepharoplasty) and raise the actual eyelid itself (upper eyelid ptosis repair).

Upper blepharoplasty (eyelid tuck)

At Alabama Surgical Arts one of the biggest complaints Dr. Nizam hears from patients seeking upper eyelid rejuvenation is they look tired and/or they can no longer place eyeliner. Upper blepharoplasty addresses these two complaints. The procedure has evolved significantly over the last 10-15 years. Prior to this period most surgeons merely removed as much excess skin and fat as possible. This unfortunately led to patients looking gaunt and skeleton like, especially 5-10 years after the procedure. Today with the evolution of modern surgical technique we now utilize tissue preservation techniques, as well as volume enhancement techniques when needed.

The procedure is performed by placing an incision in the upper eyelid crease. The excess skin is removed in a conservative fashion. At this point the procedure is tailored to your individual needs. A portion of the muscle may be removed if it is found to be redundant. Targeted fat removal may be then undertaken depending on areas of excess. Fat may be harvested and added to other regions to restore lost volume. The procedure is performed under general anesthesia or light sedation depending on patient wishes and surgical requirements. The procedure takes approximately 1 hour.

As mentioned above, upper blepharoplasty is commonly performed with a browlift/forehead lift. Often times excess upper eyelid tissue is caused by decent of the forehead and brow. An easy way of checking if you are a candidate is to simply pull your brow up with your hand and see if the excess eyelid tissue is lessoned. This will be discussed at your consultation.

Upper Eyelid Ptosis Repair

 This is the often overlooked portion of the forehead/brow/upper eyelid complex. Some individuals have drooping of the actual eyelid itself. This can occur to one eyelid causing an asymmetry or both. Ptosis of the eyelid can make the actual opening of the eye small giving a tired appearance. This can be corrected by tightening the muscle behind the eyelid itself in a simple procedure that takes 30-45 minutes with no visible incisions.

Summary: The forehead/brow/upper eyelid continuum is a complex area with multiple surgical approaches and techniques to address it. Each of the aforementioned regions has a complex interplay between them. For example, as the brow comes up from a browlift there is less skin evident on the upper eyelid. If the eyelid is moved upward with a ptosis repair there will be more excess skin above the eye. You can experiment with this by looking at yourself in the the mirror and pulling your brow up and seeing the effect on the upper eyelid skin or by slightly closing your eyes and then opening them fully and looking at the amount of eyelid skin. The skill of rejuvenation of this region is selecting the correct procedures and approaches to give a natural, balanced, and long lasting result.

Recovery: Social downtime (time that it will take for you to look presentable in public) is typically 7-10 days. For browlifts a drain is typically placed and used for the first 24 hours. A headache for the first 24 hours is common for browlifts. Sutures are removed if necessary at 7 days depending on the procedure performed and type of suture used. Complications are rare for the entire group of procedures and in the rare event they occur are usually easily managed.

Longevity: As with all cosmetic procedures we offer, the goal is to reverse the clock 10-15 years in a natural manner. The changes mentioned above a permanent in sense, however you will continue to age. The amount of this aging is depending on genetic factors, sun exposure, self care, etc. If additional surgery is desired 10-15 years later these procedures are typically some of the easiest to revise.

Click here for Upper Blepharoplasty & Brow Lift Before and After pictures