Dr. Freund's Answer: You are right about your upper eyelids and eyebrows being a bit low. Normally, you should be able to see mascara placed on the upper eyelid. In your case, you can barely see the eyelashes peaking out from under the upper eyelid.
For many people, upper eyelid heaviness is a result of eyebrow and forehead muscles sagging. To test if the is the case, look in the mirror and slowly elevate your eyebrow to a normal level. If the eyelid looks normal with this lifting maneuver, then maybe you need a browlift instead of or in addition to upper eyelid surgery (blepharoplasty).
There are several types of brow lift, all with their pluses and minuses:
- Endoscopic Brow Lift - Three to five small incisions in the scalp that does a modest job of lifting the eyebrows and smoothing out the forehead. On the downside, you could have a slight elevation of your hairline.
- Coronal Brow Lift - An incision is placed across the scalp, from side to side, one to two inches into the hairline. This is the best way to get a great lift and smooth forehead. On the downside, you will have a long scar, some scalp numbness and your hairline could be very high.
- Pretrichial Brow Lift - An incision is made at the hairline, at the top of the forehead. The result can be great with no elevation of the hairline. However, the scar at the hairline may be visible and numbness is most certain.
- Lateral Brow Lift - this is a limited version of the above procedures, designed to lift the eyebrows off of the outer third of the eyelid. The scars are hidden, the hairline stays the same and forehead wrinkles are reduced in a limited but visible way.
For those who only have excess upper eyelid skin, a upper eyelid blepharoplasty is indicated. In this case, the excess skin and fat of the upper eyelid is removed. A brow lift costs about $4,000 and blepharoplasty $3,500.
As for your nasolabial folds and other fine lines and wrinkles, I suggest a filler such as Juvederm, Restylane or Radiesse. They are all excellent, but each has its pros and cons, which are detailed in my book "A More Beautiful You - Reverse Aging Through Skin Care, Plastic Surgery and Lifestyle Solutions."
Robert M. Freund, MD, FACS
The health or medical information in this article is for informational purposes only and is not intended to be used as a substitute for professional medical advice, diagnosis or treatment. Please consult your doctor or a qualified healthcare provider with any questions.