Eyelid procedures are generally divided into reconstructive and cosmetic surgery. Reconstructive surgery is directed towards improvement from a deficit to a normal appearance and normal function. For example, patients who have skin cancer removal may require reconstruction of the eyelid using plastic surgical techniques such as skin movement surgery (flaps) or skin grafts. Here, the attempt is to return the patient to their pre-cancer appearance. Another example of reconstructive surgery of the eyelid is ptosis surgery. As we age, the muscle that raises the lid when we look upwards can become stretched out or even torn. Ptosis surgery is performed to repair this loss and also restore good lid position to its pre-injury position and function.

Cosmetic eyelid surgery is performed to help patients look better and younger while preserving and sometimes improving lid function. Cosmetic surgery of the eyelids, also called blepharoplasty, treats skin and fat excesses of the upper and lower eyelids. These procedures are directed towards removal of the excess skin and fat and the restoration of smooth contours about the eyes. The aging process can break up the smooth lines that flow from the forehead, through the area about the eyes and down towards the cheeks. Lid surgery can restore these flowing lines and thus create smooth contours about the eyelid area.

Besides skin and fat excess, another process that can make a person appear older is the occurrence and worsening of wrinkles. These wrinkles occur over the upper and lower eyelids but also within the "Crow's foot area" outside of the lids and towards the temples. Wrinkle removal can greatly help patients to looks younger.

Cosmetic eyelid surgery is usually performed by itself but may be performed in conjunction with other facial plastic surgery procedures. Various other plastic surgery procedures of the face may be combined with eyelid surgery such as a face lift, a brow lift and the use of various lasers to remove wrinkles and smooth the skin, especially in areas where a face lift cannot fix wrinkles. For longer procedures like face lifts, general anesthesia is necessary for patient comfort. Since eyelid surgery is a much shorter procedure, patients may opt for sedation anesthesia, oral sedation or even straight local anesthesia depending upon the nature of the surgery and the patient's sensitivity to discomfort.

In any event, the goal of cosmetic eyelid surgery is to achieve improvement in appearance while at the same time preserving eyelid function. Functional aspects of eyelids include the preservation of moisture over the eye itself and good closure of the upper to the lower lids.

Let's talk about good eyelid closure because it's also important in preventing dry eyes. Our eyelids require enough skin so that they can close easily and it is therefore necessary to not be overaggressive with skin removal with either upper or lower eyelid surgery. Lid closure is necessary to prevent dirt and other particles as well as water to get into the eye as these can cause injury to the surface of the eye. In addition, eye irritation and corneal injuries can be prevented when the eyelids easily close during sleep. During sleep, the lids can separate slightly and allow air currents to dry the exposed eye. Patients can awake in the morning with irritation of the eye and even develop corneal abrasions in this situation. And with the aging process, structural support and muscle tone to the upper and lower eyelids can weaken, thus increasing the chance for dryness and incomplete lid closure.

When contemplating cosmetic eyelid surgery, it is important to identify patients who may already have dry eyes because surgery can worsen the dryness. It is also important to perform surgery more conservatively in these patients and to choose procedures that will have a lesser effect on lid position to prevent the worsening of the patient's dry eyes.

When consulting a facial plastic surgeon, it is important to work with the Doctor to also identify any other issue that the patient may notice or that the Doctor can pick up during their examination of the patient. For example, some patients may have drooping of one or both upper eyelids that is not related to the patient's hooding but rather caused by stretching or a tear in the muscle or tendon that raises the upper eyelid when looking upwards. This is important because simply removing upper skin excess will not treat this kind of drooping, called "ptosis."

Another important issue in cosmetic eyelid surgery is the appreciation of other medical issues a patient may have prior to their surgery. That is why it is very important for prospective patients to tell their treating physician all of their medical issues. It is imperative that there is not bleeding with eyelid surgery and so patients who are being treated with medications in the aspirin family or any other blood thinners to discontinue these medications and over the counter substances at an appropriate time prior to their procedure. The eyelid surgeon can communicate with the patient's cardiologist or internist regarding the specific times the patient can be off their anticoagulants depending on what medical condition is being treated, for example a. fib versus simple blood thinning with baby aspirin to prevent heart attack. Other medications that can affect cosmetic eyelid surgery include steroids and other anti-inflammatory medication used to treat such issues as rheumatoid arthritis and inflammatory bowel disease. As with the blood thinning type of medications, these newer anti-inflammatory medications can be discontinued for specific amounts of time before and after a procedure depending on how often these medications are given and how necessary it is to continue them.

The most common surgical procedure performed in the United States today is upper eyelid surgery or upper blepharoplasty. Excess skin of the upper lid is first marked with a fine surgical marker. There are different techniques for marking the excess skin as well as different lengths of the incision but one thing all markings have in common is that skin removal needs to address all of the skin excess while at the same time helping to preserve the skin necessary for lid closure.

In addition to the different types of anesthesia with their varied amounts of sedation, local anesthesia is always performed with eyelid surgery. This numbness not only makes the procedure comfortable but provides relief of pain after the procedure and also allows for less sedation medicine needed for relaxation. In fact, many patients can undergo upper eyelid surgery totally under local anesthesia. It may be beneficial for some patients not to have any sedation type anesthesia in certain situations that are related to a patient's other medical problems.

Another reason local anesthetic is injected around the eyelids is to completely prevent bleeding during the procedure. This not only makes eyelid surgery very safe but also helps to minimize discomfort and swelling after surgery.

At surgery, after the local anesthetic has rendered the lids completely numb and with minimal blood flow, the excess skin is removed. There are two fat compartments within the upper lid and they are located mostly on the inside of the upper lid, close to the root of the nose. These can be removed in patients that have prominent fullness to achieve a smooth contour over the inner aspect of the upper lid. Upon completion of upper eyelid surgery, care is taken to ensure there is no bleeding. There are several different ways to close the skin but all generally result in an excellent and barely visible scar. Blepharoplasty scars are generally very difficult to detect with proper surgical technique, mostly because the skin of the upper lid is thin and therefore has a tendency to produce less scarring. In addition, when the surgical markings are made, the lower incision is placed within the "palpebral fold". This fold can be seen when the eye is closed and is the fold that the excess skin is falling over. We expect there to be a fold after the upper eyelid surgery and so it is more difficult to see the scar if it is hidden within the palpebral fold.

Removal of excess skin of the upper lid is not only rejuvenating and refreshes the lid area but it can also help to relieve the heaviness patients feel as the skin excess weighs down on the skin by the lashes beneath and also on the eye itself. Removal of this "hooding" can make patients feel better.

Excess skin of the upper lids can also limit vision, even if the skin excess is mild and not covered by a patient's health insurance.

Excluding brow lifting to alleviate upper eyelid hooding, there is generally one way to perform upper eyelid surgery and that is with skin removal. For the lower eyelids, there are several ways to provide cosmetic improvement. Because support of the lower lid is so important, it is very important to recognize laxity and other forms of lower lid weakness prior to lower eyelid surgery. The choice of what type of lower eyelid surgery is very important when there is at least minimal laxity. More on that later but let's continue to discuss treatment of the upper eyelid.

Upper eyelid surgery is almost always performed with only skin removal . With the exception of concomitant fat removal, nothing else is done. But there are certain patients that may benefit from another type of upper eyelid surgery called supratarsal fixation. These patients look like they have hooding, or excess skin like most patients but when you just remove the excess upper eyelid skin they still appear as though they have hooding. This is because the attachment of the skin excess is down towards the lashes and very close to the lid margin (where the eyelashes attach). These patients may still get some improvement and in fact may prefer to have only skin removal blepharoplasty. But patients want to have as much skin removed as is safely possible and may opt for supratarsal fixation. With this procedure, not only is the excess skin removed but, in addition the fold that the skin is falling over is raised on the lid and a deeper fold is created. This gives the lid a crisper and cleaner appearance not possible with simple skin removal.

Supratarsal fixation is also used to give Asian patients a more Caucasian appearance because it creates a lid fold uncommonly present in Asian patients. One can look at eyelid surgery photos to see the differences between these two forms of treatment. Blepharoplasty scars are the same with both procedures and are difficult to see. And eyelid surgery cost (blepharoplasty cost) is similar for both types of procedures. It is therefore very important to review the goals of surgery with a facial plastic surgeon to see what procedure is best for you.

The most important part about answering this question is the acknowledgement that a low brow "creates" skin excess within the upper eyelid. You can prove this by simply looking into a mirror and raising your brow with your fingers and seeing how much skin there is in the upper lid with brow movement.

Some patients have always had drooping of the brow, even in youth and so it is not the age of the patient that determines whether and what kind of procedure to have but the goals of the surgery. This skin excess that happens with brow drooping can be in the upper part of the upper eyelid but also in the lower part where patients usually have skin excess and so this skin excess caused by a drooping brow can be deceptive. In fact, the cause of most patients' upper eyelid skin excess is a combination of 1)a "pushing down" of skin from the brow, and 2) simply that they have skin excess within the lid. As we age, skin changes occur within the skin of the upper eyelid, including a loss of elasticity and also a stretching of the skin itself from swelling and irritation. Wrinkles may also form from the aging process including Crow's feet, smile lines, crepey skin, and even deep wrinkles about the lids themselves or within the brow.

Upper eyelid surgery and brow lifting procedures help all of these wrinkles to varying degrees and a thorough consultation with a Plastic Surgeon can help patients understand which procedure may be best suited for them and their aesthetic goals.

For patients whose hooding is mostly caused by drooping of the brow, brow lifting should be strongly considered. For patients who have brows in good position (i.e. not drooping), upper eyelid surgery may be a better alternative as it is a smaller surgery. It is important to remember that both brow lift recovery time and upper eyelid surgery recovery time are very similar and so that shouldn't affect the decision making process.

There are other considerations when deciding which surgery is best for you. Both Brow lifting and upper eyelid surgery work to remove the "hooding" or skin excess of the upper lid. Upper lid surgery is targeted at removing this skin excess only. But brow lifting covers a larger part of the face and so has a more broad effect. One should think about a brow lift as a face lift of the upper face. During a brow lift the entire forehead is lifted with improvements in not only the hood area but over the forehead, Crow's Foot areas and sometimes even down into the cheek. In this fashion, smooth transitions are created between these areas, making the patient look more youthful and streamlined. Brow lifts also work to improve wrinkles in ways that upper blepharoplasty (upper eyelid surgery) cannot achieve. Horizontal wrinkles across the forehead and Crow's Foot wrinkles are improved and sometimes eliminated with a brow lift. Since the corrugator muscle is removed during a brow lift, the vertical wrinkles and folds between the eyebrows are usually greatly improved. However, some patients may benefit from corrugator removal with upper eyelid surgery.

Some patients may want to work on facial aging for their lower face and to combine upper eyelid surgery, lower eyelid surgery and a face lift and this creates smooth transitions and makes the entire face appear the same age. Again, an evaluation with a facial plastic surgeon can best help you decide which procedure is best for your anatomy and goals. In addition, laser treatment for wrinkles can be a welcome addition when considering which procedures "go together". The presence of wrinkles can really "age" a patient and the laser is a great tool in their eradication. Generally, laser treatment is not that effective for wrinkles of the forehead as these can be deep and , after treatment, the wrinkles return because of muscle activity within the forehead. That's one of the reasons why brow lifts are so powerful and effective: these procedures diminish wrinkles of the forehead that laser treatment cannot improve. And the effects of brow lifting are very long lasting.

One other benefit of choosing a brow lift over upper eyelid surgery is that, since the lift is not that close to the upper lid margin, there is less of a chance of developing dry eyes after the surgery. This is especially important in patients who have already had upper eyelid surgery and have recurrence of their hooding (upper skin excess). These patients frequently have developed drooping of their brows with time that has made the hooding worse and a brow lift can ameliorate the recurrent hooding. These patients may have also developed other signs of facial aging as mentioned above including Crow's foot wrinkling and folding and transverse wrinkles of the forehead.

Some patients may have drooping of their brow and skin excess of the upper lid and, depending on the patients goals may want the best possible result. In this situation, upper eyelid surgery and brow lifting can be done: either combined or in sequence. When doing these two procedures in sequence, the second procedure is usually followed by the second procedure in four to six months. This allows for settling and scar maturation prior to the second procedure. The first procedure that is performed is usually the brow lift because that allows the surgeon to set the position of the brow prior to removing the residual upper eyelid skin excess. A brow lift is frequently performed with a face lift and so patients can opt for the facelift/brow lift under general anesthesia in the first procedure and in four to six months return for the upper eyelid procedure which may be performed under local anesthesia.

When patients have low brows, the distance between the brow and lid margin (where the lashes attach) can appear shorter and this can give a tight appearance within the upper lid area. Upper eyelid surgery can lead to a further narrowing of this height and create further disproportion. Brow lift surgery helps to expand the space between the lid and brow and "open up" this area which can create beauty and harmony among the other parts of the face. gain, this is just one consideration when deciding whether to have upper eyelid surgery, a brow lift or both procedures.

Loosening of skin, wrinkles and the occurrence of "fat bags" within the lower eyelid are common signs of the aging process. And since we are always looking at other's eyes in communication, we see these aging changes more around the eyes than other parts of the face. Treatment of the lower eyelid for cosmetic improvement can have a significant effect on our appearance and can make us look younger and healthier. Lower eyelid surgery can also be part of a total facial rejuvenation plan and should be thoroughly discussed with your facial plastic surgeon.

When discussing the lower eyelid area with the Doctor, it is very important to evaluate lower lid health and mostly whether the lower lid is strong enough to withstand the healing effects after the procedure. In addition, some time should be spent evaluating and discussing whether patients' tear production is adequate because that can affect whether and what type of lower eyelid surgery is performed. As will be discussed below, adjunctive procedures can be performed to strengthen the lower eyelid to prevent dryness after surgery and also to give more support to potentially improve the appearance of the lid after the procedure.

The lay public refers to fullness of both upper eyelid and lower eyelid, commonly as "eye bags". The cause of this prominence is the presence of fat pockets in both the upper and lower lids and removal of the fat is curative. Additionally, the fat pads may become more prominent because of the aging process where the ligamentous support of the eye and eyelids becomes weaker and the tissue actually lengthens to create the bags and also can lead to looseness of the lower lid which can become a cosmetic issue, in addition to causing dry eyes.

During eyelid surgery, attention is directed to these fat pads and they are removed if they are prominent. Over-removal of the fat pads can lead to a hollow appearance and so ever care is made to remove the appropriate amount of fat and not too much so as to lead to this hollow appearance. Removal of the fat pads is very safe as there is no bleeding at surgery and patients are told to be minimally active after their procedure. In addition, aspirin type products are avoided around the time of the surgery and blood pressure is carefully controlled. All of these safeguards help to prevent bleeding around the time of the patient's surgery.

As will be discussed below, excess fat present within the lower eyelid can be either simply removed or can be advanced beneath the lid to fill the area between the lower lid and cheek (lid-cheek junction). Each of these alternatives has positives and negatives and should be discussed with your Facial Plastic Surgeon. Eyelid surgery cost for these procedures is similar and so the best alternative should be chosen based on what is the best for each patient.

For patients with loose or weak lower eyelid tissue, procedures that tighten and add strength to the lower lid can be added to the open, external approach. These include various types of canthopexy procedures that can not only help with treatment of dry eyes but also help to restore a youthful shape to the eyelids.

The external approach can also provide access to the cheek beneath it and also to the area that separates the cheek from the lower eyelid which is referred to as the lid-cheek junction. Other terms include upper cheek hollow and tear trough.

Because the external approach provides excellent visualization of the lid-cheek junction and the upper cheek, fat can, in some patients, be mobilized from the lower lid and extended into the lid-cheek junction, thus smoothing this region of the face. This has the effect of creating a seamless contour from eyelash to jowl. Additionally, lifting of the cheek can be achieved via the external lower eyelid surgery approach, though swelling can be more prominent over the cheek as compared with other face lift techniques. These techniques to lift the cheek can be effective because the cheek fat is lifted by a suspension suture from above. The important thing is to fully discuss what you see going on with your Plastic Surgeon to see which technique is best for you and your anatomy.

Excess skin can be removed with the external approach and so skin folding can be corrected and smoothed out. But wrinkles, also known as crepey skin, though slightly improved with the external approach, is better treated with laser skin resurfacing because the laser is highly effective at removing wrinkles. The laser cannot be used with the external approach in most patients and so when patients have mostly wrinkles and minimal skin folding, the laser is utilized in conjunction with the internal approach to fat removal. This will be described below.

Eyelid surgery recovery and eyelid surgery cost are similar for the different types of eyelid surgery and so it is best to pick the safest and most complete alternative for treatment. Patients can view eyelid surgery before and after photos to compare what they have with the photos of other patients and can better bring up what bothers them with the Plastic Surgeon. Prospective patients can also use these blepharoplasty before and after photographs to get an idea regarding how much improvement they can expect from the different treatments. And getting a better idea as to what to expect can help keep patients relaxed because they know what will happen during their treatment, with eyelid surgery recovery and over the long term.

(Trans-conjunctival Lower Blepharoplasty)

When Dr. Newman was a plastic surgery resident (training surgeon), he performed many fracture repairs secondary to facial trauma. These accidents commonly involved bony fractures about the orbit including the bones of the cheek, the rim of bone about the eye and the bones inside the orbit around the eye itself. He noticed that when he was fixing these bones through an internal approach (inside the lid), the fat around the lid would push its way into the site. It occurred to him that the internal approach could be used in cosmetic surgery to remove fat and leave no scar. Dr. Newman's current favored approach for cosmetic treatment of puffy lower eyelids (fat bags) is to use this scarless approach.

The internal approach to lower eyelid surgery has many benefits and can be used in any patient to achieve a variety of solutions. The internal approach also gives good exposure and so all fat pads can be treated to flatten the puffy eyelid.

As mentioned above, eyelid surgery recovery is similar to the external approach. Some patients can develop some irritation of the mucosa, also called chemosis as a result of the internal approach. This irritation can be resolved with eye drops which include steroids and aspirin family eye drops.

Fat transposition can also be performed via trans-conjunctival lower lid blepharoplasty but is more commonly performed via the open approach. Lid support procedures to raise and tighten the loose or weak lower lid can also be performed with the internal approach.

Probably the best aspect of the use of the internal approach for lower eyelid surgery is that it does not weaken the structures of the lower eyelid. When the external approach is used, tiny nerves that help provide tone to the lower eyelid muscle can be stretched or separated and this results in a loss of tone for the lower lid. This is in addition to the age related weakening of the lower lid that occurs in all people. The internal approach completely bypasses the muscles and nerves of the lower eyelid because the internal incision is made through the mucous membrane inside the lid and immediately over the fat. With the internal approach, all muscles and nerves are preserved and so the muscular sling that supports the lower lid is also preserved. Also, regarding lid strength, adjunctive lid strengthening procedures can also be used to make the lid stronger and give the lower lid a better shape.

Patients with prominent fat within the lower lid almost always have wrinkles about the lower lid itself and also Crow's Foot Areas and so laser treatment of wrinkles can be safely added to the internal approach to further smooth out the lower lid and Crow's foot areas. When the laser is added to a patient's treatment regime, blepharoplasty recovery can be slightly longer because the higher energy of the laser is required to remove the wrinkles. It may become important to use the laser despite longer healing because the laser is so effective and the results can be very long lasting.

And Botox treatment to the lower eyelid and Crow's Foot Areas can be very effective but has certain limitations. Firstly, Botox treatment for wrinkles doesn't work well for the lower lid itself, except for the most lateral (outside) area because when used directly under the lid can lead to untoward shape effects of the lid margin. Around the eyes, Botox is really best for the Crow's Foot Areas. Also, Botox lasts for about 3 and a half to four months only and the effects are completely lost by that time. Laser treatment for wrinkles is a permanent way to diminish and often completely remove wrinkles about the eyes and the laser also provides some skin tightening.

Some patients who have prominent fat pads of the lower eyelids have a small amount of excess skin just beneath the lash line (just below the lashes). In these patients, fat can be removed using the internal approach (trans-conjunctival lower blepharoplasty) and a small "pinch" of skin can be removed just beneath the lashes. In this fashion, the negative effects on lid strength and support that come from the external approach can be avoided.

One can view lower blepharoplasty before and after photos to see the effects of each type of treatment.

There are some patients who have prominent fat within the lower lids and some descent of the fat of the cheek. This creates a trough between the two fatty prominences which can be bothersome for patients. In general, there are three ways to lessen and sometimes eradicate this problem. The easiest way to solve this issue is to use a filler to soften and sometimes eradicate the indentation. The benefits of soft tissue fillers are that they are nonsurgical and so no anesthesia is required and the procedures can be easily and comfortably performed with a visit to the facial plastic surgeon. The downside of filler are that they are not long lasting (often less than one year) and there is the possibility that repeated use could lead to scarring, which might change the face's natural landmark, especially as the patient ages and the fat pads lose their volume and descend.

A second approach is to raise the cheek fat pad so that the fat pad and the fat of the lid become confluent. This can be done via a mid-face lift approach or with a face lift.

For certain patients with prominent lower eyelid fat and a trough beneath, perhaps the best method involves release of the fat of the lower lid and transposing it to the trough with fixation. This fills the trough and thus softens the trough. Patients who are good candidates for this technique have a good amount of fat equally distributed across the lid and thick overlying skin and muscle to provide for good coverage.

Some patients may notice that the shape of the lower eyelid has changed with time to become more loose and the midpoint of the lid can hang down on the side, creating a bowed appearance. For others who are having surgery the Doctor may notice these changes in laxity of the lower lid. For both situations, tightening the lower lid, or canthopexy can provide the support required to not only change the lid shape and position but also to prevent looseness that may occur as an effect of surgical treatment. The laxity that can be brought on by surgery is much more common with the open/external technique than with the internal type of lower eyelid surgery.

Differing techniques have been developed for canthopexy but most involve tightening the lower lid support structures (muscle and tendon) with different types of sutures. These techniques can be combined with external and internal types of lower eyelid surgery. These techniques don't really leave blepharoplasty scars and so are good choices when they are needed as they can improve and achieve lid health.

For patients with more severe types of lid weakness, canthoplasty techniques have been developed to give very strong support and even change the level of the corners of the eyelid.

The corrugator muscles sit between the eyebrows and function to bring the brows together. Over time and with the aging process, this continued corrugator activity can lead to permanent vertical frown lines between the brows. Patients usually start with Botox that paralyzes the corrugator muscles which alleviates the lines for about four months. But after a while the lines become permanent.

There are a couple of ways to remove the corrugator muscles and each technique has advantages and disadvantages. The first way is to have the muscles removed when upper eyelid surgery is performed. About 50 to 75% of the muscle can be removed via this approach. It is possible to get access to the muscle through this approach because the muscles are located right underneath the upper eyelid incision towards the nose. Healing from this surgery is similar to upper eyelid surgery recovery. Even though this approach doesn't remove all of the muscle tissue, a good portion can be removed and this results in patients not being able to create a deep wrinkle when expressing. And in repose (unflexed) , the deepness of the frown lines are diminished permanently.

A second and more effective method is to remove the corrugator musculature during performance of a Brow Lift. Because the brow lift approach is from the top, there is very good exposure to visualize the corrugator muscles and about 90 to 95% of the muscle can be excised. This results in most patients, to complete inability to flex the muscle and smooth, unwrinkled skin between the brows.

The Crow's foot area sits outside the eyes and is one of the areas that shows our aging process, even at an early age. They appear as wrinkles that have the shape of a bird's foot with the heel of the foot set at the corner of the eyelids and the toes of the bird extend outwards towards the hairline.

Crow's Foot wrinkles, like corrugator wrinkles begin as fine wrinkles, and , with age, deepen to become folds. When folds arise, there can be some laxity and excess skin. How do Crow's feet wrinkles and folds form? The orbicularis muscle, which is the muscle that closes the eye extends as a flat muscle from the lid edges to the forehead above, the hairline on the side and even into the cheek! The portion of orbicularis that rests under the skin outside the eyes is under voluntary control and with squinting, not only does the eye close but the Crow's Foot Area flexes and even folds. With time wrinkles can deepen.

There are two terrific alternatives for treatment of Crow's Foot wrinkles and folds and the recommendation for treatment depends on the patient's anatomy, the amount and depth of wrinkles and folds, and patient goals in terms of what other parts of the face the patient wishes to improve.

For fine wrinkles, laser treatment for wrinkles gives the best improvement for the least amount of treatment. In fact, the laser is a non-surgical procedure. During laser treatment, laser light removes the surface layers of skin to get to the layers at the base of the wrinkles. In addition, there is some tightening due to the laser treatment. Upon completion, the skin that was lasered is moist and takes about 4 to 5 days to become dry. At about 6 to 7 days make up can be applied to cove the pink lasered skin. Though there is some down time with laser treatment, it can be a wonderful alternative for patients because in many cases it can remove 90% of the wrinkles of the Crow's Foot Area wrinkles and wrinkles of the lower eyelid.

When patients exhibit deep, permanent Crow's Foot Area wrinkles, they also generally have drooping of the brow, deep corrugator folds, transverse forehead wrinkles and upper eyelid hooding and are therefore great candidates for Brow Lifting. Since a brow lift treats and cosmetically rejuvenates the entire forehead, the Crow's Foot Area is expanded and smoothed evenly and completely. Therefore, a brow lift is the best way to treat Crow's Foot folding when it exists. It is, again, patient anatomy and goals that determine which technique is the best choice.

When patients have both fine wrinkling and furrowing of the Crow's Foot Areas, both laser treatment for wrinkles and a brow lift can be performed simultaneously.

It is a very good idea for patients to view eyelid surgery before and after photos to compare the degree of problems to what others have and to see how much improvement may be expected for the different issues. Looking at blepharoplasty before and after photos can also help patients understand the alternatives for treatment, and, in fact help as a springboard for discussions with a facial plastic surgeon.

CLICK HERE TO VIEW BLEPHAROPLASTY BEFORE AND AFTER PHOTOS