A comprehensive evaluation of the eyelids requires an understanding of the intimate connection of the eyelids to the eyebrows. Many patients are interested in cosmetic rejuvenation of the upper face including removing the loose, excess skin and fat hanging down over the eyelashes.

While many people will have a great result by addressing the eyelids alone, some patients will have a better result by focusing on the eyebrows. In many cases, it is actually the descent of the eyebrows that causes the droopiness and excess skin to hang from the upper eyelids. It is important to take this into consideration, because the results will be suboptimal if there is not enough of a distance from the upper eyelid lashes to the eyebrow, since it can cause a closed in look after surgery.

There are various methods, both non-surgical and surgical to help enhance the upper face. Cosmetic Botox treatments are a familiar option to many people interested in facial rejuvenation.  

An added benefit of Botox is the potential raising of the eyebrows, the so-called chemical browlift. By weakening specific muscles that cause a downward pull to the eyebrows, Botox can help to raise the eyebrows. This effect is temporary and varies from patient to patient, but certainly has positive effects.

There are many different surgical approaches to raise the eyebrows, and each has their advantages and disadvantages. The endoscopic forehead lift has been a popular approach in recent years for a number of reasons. It involves several small incisions made behind the hairline rather that a long incision from ear to ear above the head, which is performed in a coronal brow lift. The small incisions allow the placement of a camera and small instruments to help carefully release the forehead tissue and raise and fixate the eyebrows to a higher position. This approach allows for quicker recovery times and less risk of tingling, numbness, hair loss and bleeding than the coronal approach. Other approaches to brow elevation include a transblepharoplasty browlift, where through eyelid incisions, careful dissection is performed to release the outer part of the eyebrow and fixate the eyebrow to a higher position. Another approach is called the direct brow lift, which is typically reserved for men with bushy eyebrows and deep forehead lines since the incision is made directly above the upper eyebrow hairs.  

While not all people require a brow lift, proper pre-operative assessment and explanation of the various approaches helps to achieve the desired result when it comes to rejuvenation of the upper face.