Understanding the Approach: Upper Eyelid Blepharoplasty and Brow Lift
Different Approaches to Achieve Desired Results
Upper eyelid blepharoplasty and brow lift are two procedures commonly performed together to achieve optimal aesthetic outcomes. Depending on the individual’s specific needs, either an open (coronal approach) or an endoscopic approach to brow elevation may be chosen.
The Sequential Order and Benefits
Performing the brow lift before the upper eyelid surgery is often preferred to avoid the risk of removing excessive skin. Lifting the brows can stretch out the upper eyelid skin, minimizing redundancy and allowing for less skin excision. If the upper eyelid surgery is performed first, there is a potential risk of excising too much skin, which may only become apparent after the brow lift procedure.
The Open Brow Lift Technique
In the open brow lift technique, a carefully placed incision is made either behind or along the forehead hairline. The underlying forehead is then undermined, either on top of the bone (subperiosteal) or on top of the bone covering (subgaleal). Frown muscles, including the corrugators, procerus, and depressors, may be removed. In some cases, sections of the frontalis muscle, responsible for eyebrow raising and forehead creases, may also be excised. The brows are then adjusted to achieve a symmetrical and aesthetically pleasing configuration, considering the patient’s sex and preoperative preferences. A small amount of skin is removed at the incision’s edge to tighten skin laxity.
The Endoscopic Brow Lift Technique
The endoscopic brow lift technique is typically suitable for younger patients with brow ptosis (drooping), and it may also address excess upper eyelid skin and crow’s feet without significant forehead excess skin. This technique involves three small incisions made behind the hairline. The procedure requires minimal skin excision. Various fixation devices are available, with the Endotine® Forehead fixation device being a preferred option. The lateral incisions may involve small triangular skin excisions. Additionally, the lateral brow lift may be combined with the endoscopic approach to correct skin excess, particularly when performed alongside lower blepharoplasty or midface lift procedures.
The Upper Eyelid Blepharoplasty Procedure
After the brow lift, the previously marked upper eyelid skin is excised. Redundant muscle may also be removed, and the septum (the membrane containing fat-pads) is opened, either entirely or at intervals. Fat from both eye sockets is excised and compared for symmetry. The septum may be closed, and if necessary, repairs are performed on the muscles responsible for elevating the eyes. Finally, the skin and muscle are closed together on both sides.
In conclusion, understanding the different approaches to upper eyelid blepharoplasty combined with brow lift is crucial for achieving desired results. The sequential order of performing the procedures and the careful consideration of individual factors contribute to successful outcomes. Whether opting for the open or endoscopic technique, consulting with a qualified plastic surgeon specializing in eyelid rejuvenation is essential to determine the most suitable approach for your unique needs.
Check out our gallery of before and after images for blepharoplasty here.
