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Category: Eyes and Eyebrows

Beverly Hills Browlift

Descent of the eyebrows can crowd the upper eyelid space and appear as though an upper eyelid procedure (blepharoplasty) is necessary. Actually, in many instances, both raising the eyebrows (browlift) and a blepharoplasty are performed at the same time.

Direct Browlift

There are several approaches to raising the eyebrows. There is the Direct Browlift which excises skin immediately above the eyebrows. It is a fairly simple and quick procedure and should be performed in a patient whose skin does not form obvious scars. Because it is a sharp, crisp line above the eyebrow, it can be somewhat feminizing. Consequently, it is usually performed on a woman who wants a simple procedure or a man with bushy eyebrows that can obscure the scar.

There is the Mid-Forehead Browlift which excises skin through a wrinkle in the middle of the forehead. This is almost never performed on a woman and is usually reserved for balding men who have deep forehead wrinkles. In the right candidate, the procedure is very effective. However, the scars can be red for six months or longer before they gradually fade away.

Pre-Trichial Browlift

The Pre-Trichial Browlift excises skin immediately in front of the hairline. It is usually reserved for patients who have a high hairline and do not want it raised any higher. This approach can also be employed to pull the hairline forward and actually lower it.

The Coronal Browlift excises hair bearing skin across the top of the head. Because it creates a very long scar and cuts sensory nerves, which results in 6-12 months of numbness, it has given way to the endoscopic browlift. However, there are special instances when it is useful, such as exposure to drill down prominent brow bones above the eyebrows or to attempt at equalizing asymmetric eyebrows.

Endoscopic Browlift

The Endoscopic Browlift, which uses special elevators and rigid telescopes through small scalp incisions, raises and fixes the entire forehead and eyebrows after freeing them from their underlying attachments. It is probably the most popular procedure and avoids long scars and scalp numbness. However, because it raises the hairline, proper patient selection is important.

Browpexy

Finally, there are several less involved procedures that are sometimes employed. There is the Browpexy which suture fixates the eyebrow at a higher level through an upper blepharoplasty incision. Obviously, it is most commonly performed when a blepharoplasty is planned and only minimal brow elevation is sought. Because nerves and blood vessels exit the forehead bone on the medial or inner aspect above the eyebrow, only lateral brow elevation can be accomplished using this technique. And lastly, there are less effective but occasionally employed “cable” procedures. These utilize sutures placed through incisions in the scalp above the eyebrows which go under the forehead skin to lift the eyebrows.

Unsuccessful, “Successful” Cosmetic Surgery in Beverly Hills

We constantly see celebrities who suddenly look different with telltale signs of having had some plastic surgical procedure. And though the procedure may have been executed successfully, from a technical standpoint, the final aesthetic result is “off”. In many cases they look younger, but not necessarily better. And, on the other hand, in many cases they look older, though their face may appear tighter. There are many characteristics that contribute to a youthful, beautiful face. In some facelift techniques, the face appears narrower, though smoother. Since youthful faces are generally fuller, such a result would be unwelcomed and detract from the overall effect. Also, eyelid surgery that produces a “high fashion” hollowing out of the upper eyelid space may also be a questionable improvement, since youthful eyes are usually fuller in this region. And browlifting, unless performed conservatively with the difference between male & female aesthetics kept in mind, may look “odd” or inappropriate. Finally, various lip procedures may change a characteristic pout or contour into something less attractive.

So it is important for the surgeon to recognize all of these subtleties when doing these surgeries, to produce a result that makes the patient look better—not different.

Plastic Surgery Beverly Hills

When To Have Plastic Surgery

I am often asked by my Beverly Hills patients if it is the “right time” to have a certain procedure, or if they have “time to wait”. Certainly, this is a very personal issue and depends on many factors. Having a facial feature that you have never liked, as with a large nose or a receding chin, will never improve with time. So it amounts to deciding on the cost/benfit ratio and if you have the time available to recover. These patients also tend to worry that they may wind up looking worse than before. Consequently, they are torn between their desire for change and the fear of the unknown and tend to procrastinate. To these patients I say that plastic surgery, if done properly by a competent surgeon who understands your goals, will make you look better and will blend harmoniously with your other facial features. Surprisingly, though the result may be quite dramatic to the patient, it is rarely that evident to friends, colleagues and even family, especially if the patient changes their hairstyle, shaves off a moustache or does something else to alter their appearance in another way.
When we consider rejuvenative procedures such as face and neck lifts or eyelid surgery, there are some who think earlier is better and some who think just the opposite. Those who favor the earlier approach argue that the change tends to be less dramatic and, therefore, less obvious. On the other hand, those who favor waiting till it’s unbearable to look in the mirror or uncomfortable to wear tight collars think you get  more “bang for your buck” by waiting. My personal opinion is that you should try to look as good as you can for as long as you can. Since youthful skin has more elastic fibers and better collagen, it tends to re-drape and conform better producing a more rested and healthier appearance. And having a procedure earlier rather than later, allows you to enjoy the benefits for a longer period.

Enhancement of the Eyes and Eyebrows

The eyes are the first feature we see when we meet someone, and there is much to be learned from them. We can think that the person is tired, evasive, dishonest, energetic, sad, intense or even captivating just by looking into their eyes. So it is to one’s advantage to have good-looking eyes.

To this end, we like to see smooth skin without wrinkles or puffiness for both the upper and lower eyelids. There should be a crisp crease between the upper eyelashes and eyebrow, and the eyebrow should have a nice smooth arch about ½  inch above the bony rim. Obviously, allergies or any other inflammatory condition that affects the whites of the eyes would detract from an otherwise positive impression and should be corrected.

Generally, we like the outside corner of the eye to be slightly higher than the inside corner. The highpoint of the brow arch is most pleasing if it is somewhere between this outside corner and the iris or colored portion of the eye. Also, the eyebrow should start and end at the same horizontal level. We also like to see the distance between the two eyes approximately equal to one eye width.

Though many of us are born with naturally beautiful eyes, much can be accomplished with the appropriate use of make-up and the appropriate surgical procedure(s), if indicated.