today we're going to discuss brow lifting and why it's an important consideration when you're planning on doing upper eyelid cosmetic surgery i'm dr joel koppelman i'm a facial plastic surgeon in manhattan i'm an expert on eyelid and eyebrow lifting and i've been doing this for over 35 years and i'm going to explain to you why it's important to do a brow lift when you consider doing upper eyelid surgery so what actually happens with your forehead and your brow with time as we age of course some people are born with low brows but most of us
age when we age our brows starts to descend particularly in the corners and the lateral hooding occurs and this hooding is due to a sliding effect of these tissues and the temples okay because the attachments over here are very loose and as we age they actually get much more loose and they descend and they create this hooding effect here so that's where we see it first with time of course all the brow starts to descend downward and it is critically important that you analyze the brow in relation to your eyelids and you can do it
at home by looking in the mirror just raising your brow to see what an effect raising your brow has on your upper eyelid itself so as we age this brow descent is actually sandwiching or pushing the tissue downward down to the eyelashes and you start to form this fold of upper lid lacks skin now some of the skin is is actually lacks but there's also part of that problem is actually this downward descent so our objective is to raise the brow up so that it gets back to its normal position sitting right on the rim
of our socket over here now not every patient who's considering upper eyelid cosmetic surgery needs a brow lift i want to make that clear there are many many patients who just simply can have upper eyelid lack skin removed and not have a brow lift as well but there are patients who come in and see me in consultation and say dr copeland i want to i want my eyes to be tightened up and look more youthful what i see at that moment is that their brow is actually a big component of their upper eyelid laxity so
i then go into the discussion with them why brow lifting is a important consideration in their case to rejuvenate the upper face now some patients clearly don't don't want any of this additional surgery they think it's highly risky which it isn't and we'll go into the details of that in a minute if they choose not to have a brow lift it then changes the whole way of performing the upper eyelid surgery itself because you have to compensate for that brow descent and it doesn't give as natural an appearance in the end okay so now you
have two options one is you do your upper eyelids alone and the second option is to do your eyelids and the brow together if you choose just to do your upper eyelids alone however you have to extend the incision beyond that little pooch of skin over here so you may have an incisional line that extends beyond the rim of the of the socket now the second option is to raise your brow which lifts that little pooch of skin upward so this incision line is limited inside the rim here which will be less noticeable later on
and that's why we consider brow lifting and eyelid surgery together so let me tell you about the different types of brow lifting that exist and i'm going to tell you which one i prefer in the past we would do a coronal brow lift which is an ear to ear incision and lift the brown sometimes over correct the brow and doing that in addition by making an incision horizontally across the scalp you can lose some hair you can get some numbness it's not a technique that i would recommend the other approach is a direct brow lift
and that is making incision right above your brow itself and taking a little tissue out over here and then suturing it up unfortunately that also leads to scarring commonly above your brow and you cannot be necessarily camouflaged some people try to do brow lifting directly through the eyelid itself and raising the brow that way by releasing some of the muscles here and underneath the brow here and i don't find that to be a long lasting approach either doctors do use other techniques like temporal brow lift which i think doesn't really last very long because they're
not releasing certain structures underneath the skin and the other approaches lead to other secondary morbidities which we don't want to have i prefer doing an endoscopic breath lift i've been doing it for over 30 years and that to me is the best way to get a long-term improvement in your brow position now we're going to go into detail about exactly how a brow lift is done endoscopically and that is it's very simple there are small incisions made on the scalp and i use a a camera attached to an endoscope which is a kind of like
a long telescope and i can look underneath the skin and soft tissue and release certain structures along the brow so that the brow rises naturally upward and then it's fixated upward for several weeks and the brow sticks down at a higher position okay by doing that you're raising this brow tissue off the eyelid and the amount of tissue we remove from the upper eyelid is smaller than if we don't do a brow lift the recovery from an endoscopic brow lift is relatively quick and painless i just usually prescribe extra strength tylenol every four to six
hours in the first day after which it's usually unnecessary to take anything else in addition by placing a drain underneath the skin at the time of the surgery i drain away any fluid that may collect under the skin and it reduces the swelling and bruising that can occur from a brow lift so that's one way that's the healing process is accelerated and then within four to five days after the surgery the sutures in the upper eyelid are removed and there's some staples that are left in place for about a week to 10 days after which
they're removed and no scalp is removed at the time of the procedure so that the healing time is very quick and you're back into the action very quickly following this procedure endoscopic brow lifting in my book is the best approach compared to temporal lifts which as far as i'm concerned only last a short period of time and a coronal brow lift is really old hat and really rarely used in patients so i think the endoscopic approach has stood up over the last 20 years to be very effective approach to raising the brow with minimal side
effects so i think you should choose that approach when you go to your surgeon if you choose to do it in addition to your upper eyelid surgery so i hope this video was informative and clarify why you might need a brow lift in addition to upper eyelid surgery and if you have any questions please leave them below please subscribe to my channel and i look forward to seeing you again my future videos
