By Dr. Philip Solomon & Nancie Heiber
The first signs of aging can often be seen in the eyes, which are the windows of the soul. Skin can start to sag on the upper eyelids, impacting makeup application and vision, and creating a tired appearance. Why does this occur and what can be done to reverse the aging process? And how do the eyebrows play a role? Dr. Philip Solomon MD, FRCSC, Otolaryngology, Head and Neck Surgeon, practising Facial Plastic Surgery in Toronto, answers our questions about the relationship between eyelids and brows and how aging impacts them.
Living Luxe (LL): What causes our eyes to look older and aged?
Dr. Philip Solomon (PS): The natural aging process, which includes gravity, is a main contributor to the aging face. Throw in a loss of collagen, which impacts the elasticity and density of the skin, muscle weakness around the eyes, fat deposits shifting to create eye bags, and falling brows that no longer sit where they used to—and there’s your recipe for aging eyes. Botox, while a great anti-aging tool, can also drop brow position over time. We often see patients who have undergone Botox treatment for many years and find their brow position has fallen, impacting the upper eyelids.
LL: What can be done to address aging upper eyelids?
PS: Upper blepharoplasty is a surgical procedure that addresses the “hooding” or excess skin directly on the eyelids. An upper bleph, as we call it, can be carried out while the patient is awake in a one-hour procedure. A carefully placed incision is created in the crease of the upper eyelid, which conceals scarring and heals quite nicely in just a matter of weeks.
While an upper blepharoplasty can be very effective in addressing excess skin on the upper eyelids, it does have limitations in what it can achieve when the source of sagging skin on the eyelid hooding is also coming from the brow position. In this case, a brow lift may be needed either in isolation or in combination with upper blepharoplasty.
LL: What are the different types of brow lifts and which one addresses the eyelids?
PS: Most brow lifts will impact the upper eyelids to some degree. However, some will have a greater impact than others. An open, or coronal, brow lift will provide the greatest impact on the upper eyelids. A less invasive endoscopic brow lift can improve upper eyelid hooding as well, but the degree depends on the patient’s anatomy. A temporal brow lift addresses only skin so it mostly affects the position of the lateral brow without much change to the upper eyelids.
LL: What if a patient is a candidate for a brow lift but wants only to do the upper eyelids?
PS: We always educate patients about their anatomy and which procedure best addresses their concerns. We will make recommendations based on their anatomy, their goals and what’s needed. Some patients may desire a subtle enhancement, and an upper blepharoplasty may be ideal. Other patients have low brows as their main issue, causing fullness and hooding. In this case, brow repositioning is advised. In other patients, both procedures will be suggested for optimal results.
LL: What does an upper eyelid and brow lift combination procedure entail?
PS: If a patient is a candidate for a brow lift and upper eyelid surgery, we have to determine which brow lift is appropriate. A patient with a shorter forehead would probably be a candidate for an endoscopic brow lift, while patients with a higher forehead would benefit from an open brow lift. We would first carry out the brow lift to get the brows into their ideal position. Once they have been surgically repositioned, we then determine how much skin needs to be removed from the upper eyelid region. Both upper blepharoplasty and brow lift surgery can achieve quite impactful outcomes with results patients can enjoy for many years to come.