I have already spoken on the subject of the browlift, but a picture is worth a thousand words.

before and after

Many young women come to my office when they start noticing a little bit of “extra skin” on their eyelids. They have heard about eyelifts (blepharoplasty), and how easily it can be performed- under local anesthesia, in the office, in 1 to 2 hours. Naturally, they are very interested.

While I am not against eyelifts, I counsel patients to think very carefully about it, because eyelifts can have undesirable effects, such as a “crowded” look around the eyes that is not necessarily youthful. Look at the two pictures above, the picture to the left is before eyelift surgery and the one further down and to the right is after eyelift surgery. The red arrow on the left eye is the same size in both pictures. What you will notice is that the distance between the brow and the eyelid shortened markedly in the after surgery picture. This creates a more “crowded” look around the eyes, certainly not the more open look of youth.

There is a reason for this. When your eyes try to focus, you “squint” your eyes, or squeeze your eyelids closer to focus better. Since the eyelid muscles are connected to the tissues of the brow, gradually the brow attachments to the brow bone relax, and gravity brings the brow down. This bunches up the skin above the eyelashes. But this is not “excess” skin, it is only bunched up because the brow came down. The eyelashes feel the weight of the “excess” skin pushing down and send the brain a signal to lift the brows in order to get the “excess” skin out of the way. This is how you get forehead wrinkles. It comes from years of lifting the brow to get the skin out the way.

If you cut away the “excess” skin with an eyelift, the brow no longer needs to be lifted so it relaxes and drops again. That is why the distance between the brow and the eyelid is shorter in these ‘after eyelift’ surgery pictures. That is also why some patients complain after surgery that “not enough skin was taken off”. What happened is not that the surgeon took too little skin off, but that the brow dropped some and now skin is bunching up again.

At this point, if you cut more skin off, you run the danger of the eyelids not closing properly, allowing the tear film to dry too fast, and irritating the eyes. This is called “dry eye syndrome”.As we can see, the problem is not “excess” eyelid skin, but brow position.

In order to refresh the eye to a natural position, the brow needs to be lifted. This will have the effect of lifting the upper eyelids. For this reason I prefer an endoscopic brow lift. Scars are minimal, recovery time is minimal (7 days), and it has a better result. In my next post I will address endoscopic brow lift.

Ricardo L Rodriguez, MD

Board Certified Plastic Surgeon