Facial Plastic Surgery Questions and Answers: Part 7

Question: Revision eyebrow lift. Would scar tissue interfere with new surgery? 
Answer: Even after a Direct brow lift, you still have brow ptosis, therefore a coronal approach brow lift would be a better solution.

Question: Addressing signs of aging around the eyes: Non-surgical methods or straight to brow lift and blepharoplasty? 
Answer: From the photographs presented, you do not need a brow lift procedure, since the height of your eyebrows is acceptable. You do have asymmetrical eyelids, so just a conservative upper blepharoplasty procedure would be all that is recommended. An upper blepharoplasty procedure can be performed under local anesthesia as an outpatient procedure. Botox is the best treatment for crows feet.

Question: I was suggested a fat transfer to address the hollowness beneath my eyes. Should I also go for a brow lift? 
Answer: From the one very limited photograph, there appears to be low set eyebrows in addition to scleral show on the lower lids. Consider a brow lift procedure to raise the eyebrows, and A canthoplasty procedure to reduce the scleral show in the lower lids.

Question: Revision brow lift after endoscopic brow lift failed?
Answer: A full set of facial photographs are required to make a determination about being a candidate for a brow lift procedure. In our practice, we perform a coronal brow lift which can accomplish lifting and adjusting the asymmetry in the eyebrows, raising or lowering the hairline, and adjusting the muscles of the forehead to improve the vertical and horizontal lines. It’s also important to wait at least a year after your first plastic surgery before embarking on another forehead lift.

Question: Is brow lift, blepharoplasty, or a combination the best solution to my droopy look? 
Answer: More photos are going to be needed to make that determination, however from the one limited photo it appears of the brow position is acceptable. An upper blepharoplasty procedure can accomplish removal of the hooded and extra skin and the upper lids. When performing a brow lift procedure, it’s possible to raise the airline, or lower the hairline depending on placement of the incision.

Question: Brow bone reduction, rhinoplasty, mini facelift/cheek lift – are these edits achievable? 
Answer: You’re not a candidate for a facelift or a brow lift, since you’re still very young. The amount of change or trying to obtain with a brow bone reduction is not worth it. Regarding your nose, it is possible to improve your side profile, however the nose is a three dimensional structure, therefore a full set of current pictures are required to make a determination about how best to proceed. A closed revision rhinoplasty can accomplish your goals with all the incisions placed on the inside of the nose. Digital computer imaging done by a rhinoplasty specialist would also be helpful to understand what can be accomplished with your nose upon your facial features.

Question: Botox before or after endoscopic brow lift – which order is more beneficial for healing and results?
Answer: In our practice, we do not perform an endoscopic brow lift for a variety of reasons. The coronal approach gives much better, and long-lasting results. With the coronal approach, you can adjust the hairline upwards or downwards, improve asymmetry of the eyebrows, and soften both the corrugator and frontalis muscles which helps with both horizontal and vertical expression lines in the forehead. Botox is usually not required after the surgery if the muscles have been correctly softened during the surgical procedure.

Question: Maintenance for Brow Lift w/ Botox – how many times a year should I get it?
Answer: In our practice, we do not perform an endoscopic brow lift, just the coronal approach which can accomplish softening of the corrugator muscles which create the vertical lines in the forehead and soften the frontalis muscle which creates the horizontal lines in the forehead. As long as those muscles have been softened, no maintenance is required. Much more information is needed such as a full set of facial photographs to determine if your candidate from brow lift procedure.

Question: Would I be an ideal candidate for a nonsurgical rhinoplasty and brow lift? 
Answer: To lift the Central Part of your eyebrows will require a surgical brow lift, and Botox cannot accomplish that. We do not recommend nonsurgical rhinoplasty because of the potential for vascular occlusion and skin necrosis. A Closed rhinoplasty is required to be able to shave down dorsal hump, refine the nasal tip, lift the tip of the nose and narrow your bridge line. Also important to release the depressor septi ligament which dynamically pulls the tip of your nose down when smiling. Choose your surgeon wisely based on extensive experience, since rhinoplasty is the most difficult procedure to performed correctly in the entire field of cosmetic surgery.

Question: Direct brow lift before mini facelift?
Answer: Much more information is needed, such as a full set of facial photographs, and your age to determine which is the appropriate procedures for you. A brow lift is only performed for patients who have a low set eyebrows, and we make the incision in the forehead behind the hairline in order to raise the low set eyebrows. In addition, we also soften the corrugator muscles to prevent the eyebrows from being pulled down by the corrugator muscle. Mini facelifts tend to give mini results, and we rarely ever perform them. The goal of a lower face and neck lift procedure is to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove fat deposits in the neck which also includes a platysma plasty to significantly improve the jawline. A facelift and a brow lift are two completely separate procedures that can be performed separately, or together under one anesthesia with one recovery.

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