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Q: My upper lids droop over my eyelashes and I would like to have them fixed. I have seen two plastic surgeons, one who agreed that he could help me with my upper lids, another who told me I’d have to have a brow lift as well. My brows are fine with me and I do not understand why a brow lift would be necessary? Why would a surgeon recommend a procedure I did not ask for?

A: You really should go and have another talk with your plastic surgeons – if one recommended a brow lift, he should have explained why he did so. Rarely would we suggest a procedure about a body part not brought to our attention by a complaint originated by a patient. For example, we would never comment about very large or small breasts if a patient came in to discuss an abdominoplasty (i.e. “tummy tuck”).

The two exceptions I can think of relate to chin implants and brow lifts, but in such a situation, I sure would hope that the patient left the consultation with an understanding of why we are recommending the brow lift or chin implant procedures! Patients with weak chins who come in complaining of a large nose or a droopy neck cannot get a great profile without addressing the weak chin because the chin, nose and neck all contribute to the profile. Likewise, if a patient complains of heavy upper eye lids, we have to analyze the balance between the eyelid and brow position.

As a plastic surgeon, our duty is to lay out the options for a patient and each person has to choose the procedure(s) that will give them their desired results. In a pure upper eye lid blepharoplasty, the thin skin excess of the lids is removed but the distance from the lashes to the brows is not changed. In patients with low brows, removing the thin, excess upper lid skin may not be appreciated unless the thicker tissues just below the brows are raised as well. This is not to say that every low brow must be raised when doing an upper lid procedure, but the patient has to understand that only the thin, upper lid skin excess will be removed, that the thicker brow hooding will be unchanged, and that the distance between the brows and lashes does not change with an isolated blepharoplasty.

If a patient desires a more open – eyed look, this will only be accomplished if a brow lift is added to the eye lid procedure. Not only will the eye area look more open following a brow lift, but during a brow lift, the frown lines between the brows will be minimized because we can remove some of the muscles that cause these frown lines, called the corrugator and procerus muscles. And finally, occasionally I’ll see a patient with hooding caused by low brows who thinks they would like an upper eyelid blepharoplasty, but when I gently elevate the brows, I can see that this patient does not have an excess of thin, upper lid skin, just low malpositioning of the brows and I will recommend to this patient that a brow lift be performed without a lid procedure per say.

A brow lift is a minimally invasive procedure. In the endoscopic brow lift, a few half inch incisions are made behind the hair line, allowing the instruments to be inserted. The tissues are freed from the bone, the muscles sculpted, and the brows raised a few millimeters. The brows are fixed in their new position with a variety of devices. The incisions are rarely perceptible after healing has taken place. Occasionally, a brow lift will be performed as an isolated procedure, but more commonly it will be combined with a minimally invasive midface or thread lift, an eyelid procedure or a standard face lift.

If you have any specific questions about cosmetic procedures, you should see a qualified, board certified plastic surgeon to review your options and have additional questions answered!

About the author of this article:

Dr. Bunkis,MD, FACS of Orange County Plastic Surgery is a Harvard trained, Board Certified Plastic Surgeon and has 30 yrs of surgical expertise. Call OCPS at 949-888-9700, email your questions to info@ocps.com or visit our website for more information.

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Question: I’m a 28 year old Chinese female and dislike my eyelids. My eyelids have always had a flap of skin that hangs down to my lashes. I would like to have the extra skin removed from my lids but am afraid of not looking Chinese to my family. Can you do eyelid plastic surgery and still have a patient look Oriental?

Answer: You ask some very good questions about Oriental eyelids. Please read below and contact me at Orange County Plastic Surgery if you have any further questions concerning this, or any other cosmetic surgery procedure.

First of all, Oriental patients do have different eyelid anatomy than most Caucasian patients. In the typical Oriental type of eyelid patient, the superior palpebral fold (the upper lid fold between the lashes and brow) is absent. This occurs in approximately 50% of Oriental patients and is a genetic feature that is passed on from parents to their children with a dominant gene. The Oriental eyelid without a palpebral fold is often referred to as a “single eyelid”, while an eyelid with a fold is called a “double eyelid”.

Operations designed to construct a superior palpebral fold are becoming more popular in Oriental patients around the globe. This surgery has become commonplace in large cities in the Orient as well as in the United States areas, especially in areas like Orange County containing large Oriental populations. The “single eyelid” occurs because a muscle called the levator palpebrae ends within the substance of the lid, instead of attaching to the top of the cartilage plate in the lid, and is not caused by a skin excess! In such procedures, every attempt is made to create the desired fold but not to alter the general shape of the eye or to destroy the web that many Oriental patients have medially, near the nose. Destroying this epicanthal fold would make a lid look more Caucasian and destroy this important Oriental feature of an eyelid and give the patients and eyelid version of Michael Jackson’s nose – this is to be avoided!

As mentioned, 50% of Orientals lack the palpebral fold, but the other 50% do have such a fold – the Oriental eyelid procedure is designed to create such a fold and still leave the patient looking Oriental. A surgeon doing such surgery should be familiar with the differences between Oriental and Caucasian anatomy. It is possible to get a very good result with this plastic surgery procedure, but as with any cosmetic procedure, it is important to research the options and all potential outcomes. It is also important to communicate with your surgeon about how you would like to look after the surgery and obtain comprehensive pre-procedure and post-procedure information.

If you have any specific questions about the Oriental eyelid, plastic surgery procedure, or any other cosmetic procedure, your best bet would be to see a qualified, board certified plastic surgeon to review your options. A plastic surgeon should be able to work with you to get a result with which you are satisfied!

About the author of this article:

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