Thank you for your question.
You submitted a photo and you state that you have deep set eyes and your basic question
is should you get an upper eyelid blepharoplasty or temporal brow lift.
Now you’re also asking additional levels to the same question about will the temporal
brow lift lifts the cheeks and improves the nasolabial fold.
Well, certainly I can share with you my overall approach to patients like yourself who come
to our practice and I’ll tell you some of the things that help me guide my patients
as to what I would recommend.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
Helping people improve the appearance of their eyes and their cheek area and their face is
a significant part of my regular practice every day.
So certainly, when you ask a question like this, you can be sure that if you go to 5
doctors or 10 doctors you will get a different set of opinions from each one and it can certainly
be overwhelming.
What I try to really understand from my patient is what kind of outcome are they looking for.
And generally speaking, people want to look fresh, they want to look good, they want to
look natural.
And in the modern world where so many people have an exaggerated appearance from what many
people consider too much plastic surgery, there is no shortage of examples where people
say to me, “I don’t want to look like so and so, I don’t want to look like so
and so.”
So, I would say that looking at your overall appearance, when I look at your brows, my
initial impression is that your brows are not too low and therefore I would caution
you about a brow lifting procedure.
Now a brow lifting procedure in a more traditional sense is a procedure, whether endoscopic brow
lift or even a temporal brow lift, you are trying to get at least the tail of the brow
up at a certain level.
Well, when you look at your photos, I would suspect that the tail of the brow may be slightly
lower than it has been in the past but I would suspect that it’s more likely a volume issue.
So there might be some value in doing something less invasive such as adding filler to the
temporal area as well as something like a Botox® brow lift where there are injections
of Botox® done to slightly elevate the brow.
Now, of course the downside of that is there is maintenance involved but I think that since
the beginning of my career more than 20 years ago, I’ve always felt that if you really
want to make someone look plastic, do an aggressive brow lift on someone whose brows are not that
low and I have to say that a lot of my colleagues really feel strongly about doing brow lifts
so it really has to be a match between the doctor’s aesthetics and patients’ aesthetics.
That being said, I would suggest that you also think about whether or not you are dealing
with sagging versus volume loss when you’re talking about the cheek area and nasolabial
fold.
One of the most common things that we have shifted in our overall approach is perception
of what is sagging versus what is the result of volume loss.
In the beginning of my career as a surgeon, our goal was to always lift things because
tissues would sag and the options were more limited.
Now, move the clock forward, we can actually do a lot more and still get really nice outcomes
without doing aggressive surgical procedures.
Now, I do a lot of facelifts and I do a lot of the classic cosmetic procedures in the
face for facial aging but I have found that for someone like yourself, a conservative
approach may be optimal and this may include something like an upper eyelid blepharoplasty
where a small amount of skin in the hooding area in the side is reduced.
And depending on whether or not the eyelids look low to you and looking at what you looked
like in the past, there may be some other options to explore.
Now that being said, the other areas that we typically enhance such as the area you
are concerned about like the cheek, nasolabial fold, we actually do a lot with something
called structural volumizing.
Structural volumizing means placement of long lasting fillers at a deeper level along the
bone structure so that when the filler is placed, the bone structure is restored.
One of the least appreciated things that is overlooked by both patients and surgeons is
that bone loss is a significant part of facial aging and that causes the face to go inward
and the tissue to go downward and inward so restoring volume actually plays a big role.
So, I think that it is important to get a full assessment in order to really understand
what is optimal for you.
When I evaluate my patients, I take photos from multiple angles, I review everything
with them and I try to help them understand what is the difference between sagging versus
volume loss and then we come together and work on a plan that will be optimal for them.
So meet with qualified, experienced cosmetic surgeons.
Take good notes and don’t get overwhelmed by the many different opinions that you will
probably receive.
You have to be in the driver’s seat.
You have to decide what will look right for you and what level of invasiveness you’re
most comfortable with but ultimately understanding the problem defines the solution.
So I hope that was helpful, I wish you the best of luck and thank you for your question.