Many patients come to see us complaining of excess upper eyelid skin.  At times, the issue is purely cosmetic but for others the condition can get to the point where their vision is obstructed.  Some of these patients benefit from upper blepharoplasty (eyelid surgery) alone, but for many patients, the underlying problem is actually related to the position of their eyebrows.

What is eyebrow ptosis?

This term means eyebrows that are droopy.  When the eyebrow is too low, there can be many cosmetic and functional consequences.  The upper eyelid skin becomes “bunched up” when the brow is too low, creating an aged look that can block your ability to look upward and see objects clearly.  In addition, the forehead muscle has to work overtime because it is straining to hold the drooping eyebrows up.  This can create transversely oriented wrinkles across the forehead from the extra effort.  Patients may also be aware of this sensation and complain to their Plastic Surgeon that they are constantly straining to see adequately.

So, how can I tell if I have an eyebrow or eyelid problem?

This can take a little bit of judgement, but an easy way to tell is to examine the position of your eyebrow in relation to the bony upper edge of the eyesocket. In women, the brow should have a gentle arch and be completely above the edge of the socket. If your brow is too low, you can elevate it manually and see if it creates a pleasing effect and if it improves the appearance of the eyelid skin. In men, it is desirable to have a relatively low and flat eyebrow.

How can the position and shape of my eyebrows be improved?

An endoscopic browlift is the definitive way to elevate and shape the brows. The endoscopic approach limits the incisions to within the scalp so there are no visible incisions. It also limits the drawbacks and complications associated with the classic “coronal” brow lift.
For patients who are not ready for surgery, Botox injections can be used to alleviate wrinkles and improve the shape of the brow.

Will a browlift eliminate the need for eyelid surgery?

For some patients, the browlift completely corrects the excess upper eyelid skin, but others will also require eyelid surgery, which is performed at the same time.

Will insurance cover this procedure?

If you feel that your vision is blocked by the upper eyelids, insurance may pay for browlift or eyelid surgery. These patients require a preoperative visual field test to determine if a functional deficit exists.

About the author