Heavy upper eyelids can have two sources, and they call for different operations. Sometimes the lid itself carries loose skin. Other times the eyebrow has dropped and pushed the skin above it down onto the lid, and an eyelid procedure alone will leave the underlying cause in place.

The brow is the part patients overlook. Dr. Leo Lapuerta, a triple board-certified plastic surgeon in the Houston area with more than 30 years of experience, performs brow lifts, also called forehead lifts, for patients whose brows have sagged or lost symmetry with age.

Two sources of a heavy lid

A mirror gives a rough preview of the difference. Rest a fingertip above each brow and lift to where the brows sat years ago. If the lids clear, some of the heaviness comes from the brow. If loose skin still folds over the lid, the eyelid has its own excess. Many faces show some of both, and a surgeon’s exam is the place to sort out the proportions.

According to Dr. Lapuerta’s practice, a brow lift raises the eyebrows and smooths the forehead, which can make a face look more rested and alert. The practice also notes that one of its techniques treats a sagging eyebrow and eyelid together.

The brow lift has a defined territory. For jowls and wrinkles along the lower face, the practice points toward a facelift instead, and it notes that the two procedures are sometimes combined.

Three ways to lift a brow

Dr. Lapuerta chooses among three techniques based on facial structure and goals:

• Eyebrow incision, or direct brow lift. The incision goes in the natural crease of the upper eyelid, and depending on the structure of the brow, he may make one at the brow hairline. He lifts weak and sagging skin and tissue and reattaches it to the brow bone. This approach leaves the forehead alone and works on a sagging brow and lid.
• Endoscopic brow lift. Several small incisions, 1 inch or smaller, go near the forehead hairline. Through them he places an endoscope, a specialized camera, and uses surgical tools to raise the brows. The stitches sit inside the incisions to limit scarring. The change in brow position is subtle, and the practice acknowledges that results with this technique can sometimes be unpredictable.
• Coronal brow lift. The incision runs several inches above the hairline. It is long but hidden by hair. This approach can produce dramatic results and in most cases moves the hairline higher. The surgeon sometimes removes hair during closure.

The practice says experienced surgeons work within a patient’s facial structure and skin tone to avoid a wide-eyed or hyper-alert look, and that results are often subtle.

Botox first, or surgery

Botox can soften forehead wrinkles and fine lines. According to the practice, it will not lift the forehead or correct sagging and drooping features. Dr. Lapuerta’s practice suggests that a patient weighing surgery may want to try Botox first; if the result falls short of the goal, a brow lift will probably help.

A brow lift begins with a consultation, followed by a separate pre-operative appointment before the surgery date. The procedure takes around two hours, depending on the approach, and the practice performs it under general anesthesia as an outpatient procedure in an accredited surgical facility. Dr. Lapuerta has facilities in Houston, Katy and Pearland, and he works only with physician anesthesiologists.

Recovery and how long it lasts

After surgery, Dr. Lapuerta tapes the forehead or wraps the head to limit bruising and swelling, and places a small tube at the incision to drain blood and fluid. Patients keep the head elevated and avoid physical activity. Most return to work and normal activities within 10 to 14 days, and several post-operative visits cover dressing changes, suture or clip removal and incision checks.

Some patients worry early on that the face looks uneven. The practice calls this a common anxiety; features settle once swelling and bruising subside, over a few weeks, and the final result can take several months. Like any operation, a brow lift carries risks that belong in the consultation.

The incisions sit along natural folds and hairlines and the practice describes them as well concealed once healed. The practice estimates that brow lift results last roughly 10 to 12 years, in some cases longer, though aging continues and results vary from person to person.

This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.