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Question:
Does an endoscopic browlift involve surgery?  My droopy eyelids make me appear tired all of the time. I am 50 years old and have never had plastic surgery of any kind.

Answer:
There really is no fix for droopy eyelids that comes close to the results that are obtained with eyelid or brow lift surgery.  Endoscopic brow lift is a surgical procedure, however, the brow lift can be performed under local anesthesia with IV sedation so that your recovery is quite easy and unlike straight local anesthesia, you are calm and relaxed during your brow lift or upper eyelid surgery.

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Question:
I am a woman with a high brow line. How can a forehead lift be performed on me so that my scars are not as visible?

Answer:
The biggest consideration that needs to be made with regards to brow lift surgery is whether the surgery should be performed endoscopically or open.  I typically like to perform endoscopic brow lifts as I feel that the incisions are smaller, there is a lack of scalp numbness following the procedure, and most importantly, I can achieve excellent results with an endoscopic brow lift.  One particular situation that I may elect to perform an open brow lift is in a female with a high hairline.  The reason for this is that when the brow and forehead are elevated, the hairline will also elevate and this may give an abnormally high hairline post brow lift surgery.  I can avoid this by performing a pre trichal (pre hairline) brow lift.  The pre trichal approach will actually lower the hairline relative to the height of the brow and the scar is well camouflaged with the natural frontal hairline.

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Question:
Dysport and Botox seem to do the same thing. Is one more advantageous than the other for a woman in her mid-fifties with heavy frown lines?

Answer:
Botox and Dysport are equally effective in the treatment of heavy frown lines of the forehead.  There is a recent study that supports the advantages of Dysport in crow’s feet.  The effect of Dysport in reducing the contraction of the muscles that result in the formation of crow’s feet was statistically greater than the results achieved with the use of Botox.

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Question:
What is a Botox brow lift and how effective is it?

Answer:
A Botox browlift is typically the use of Botox to raise the brow,  Brow elevation with Botox is performed by weakening the muscle around the eye that depresses the brow.  The muscle is injected with Botox and the muscles that typically elevate the brow are left unopposed so the brow will elevate.  The Botox browlift is very effective, but not a substitute for a surgical browlift and the results will only last as long as the Botox is active.

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Question:
I had Botox injections in my forehead and crow’s feet. Since then, my right eyelid has begun to droop. It’s still soon after my procedure but I’m concerned this will not clear up. Is this normal? Will it clear up and how long does it last?

Answer:
Eyelid drooping following the injection of Botox and Dysport can be the result of too many injections into the forehead musculature with resultant drooping of the brow, or it is possible that you have developed ptosis, or weakening of the eyelid muscle from the Botox or Dysport migrating into the muscle and causing this drooping.  You need to follow up with your physician so that they can evaluate the cause of your drooping eye and determine the best remedy for this problem.

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Question:
I am male, 55 years old and have a tired appearance most of the time. I believe it is due to permanent circles under my eyes.  I have been looking into blepharoplasty. It looks like you remove the fat that is causing the circles. But wouldn’t that create loose skin? Do you remove some skin as well?

Answer:
Dark circles under the eyes are only partially responsive to blepharoplasty surgery.  The theory is that blood has "leaked" into the skin from the vasculature of the lower lids, primarily from the fat of the lower lids.   Removing excess fat of the lower lid can help decrease the pigment of the lower lid, but, it may not completely clear the dark circles of the lower lid.  Removing fat from the lower eyelid during blepharoplasty does not lead to loose skin.  Having said that, the decision to remove skin at the time of your eyelid surgery because of excessive skin is a decision that is made preoperatively during your eyelid surgery consultation.  In other words, if you need skin removed from your lower eyelid it would need to be removed with or without the removal of fat from your lower eyelid, and this is determined before eyelid surgery is started.

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Question:
Would my vision be affected during the healing process after eyelid surgery?

Answer:
Your vision should not be affected as a result of eyelid surgery.  However, one of the potential complications following eyelid surgery is transient chemosis, swelling of the outer covering of the eye, and swelling of the eyelids.  These two issues resolve in a short period of time but during the healing phase, chemosis and eyelid edema could affect your ability to see clearly for several days.

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Question:
How many rhinoplasties are too many? I’ve undergone a total of five procedures and I still don’t feel like the work of the first doctor has been sufficiently fixed. Is it still possible to have my nose fixed?

Answer:
Five rhinoplasties is a lot of surgery.  Unless your nose is significantly deformed or severely functionally impaired I would suggest refraining from any further rhinoplasty surgery.  Depending upon the amount of work that was performed on your nose it is likely that after three rhinoplasty surgeries the normal anatomy is unidentifiable and further surgery may only cause further damage to your nose.  I would only be able to tell you if you have had too much rhinoplasty surgery after examining you personally.  If I felt that I could significantly and safely improve the issues that you have had with your nose, then I would proceed with revision rhinoplasty.   If the issues are relatively minor in my opinion, then I would not perform the revision rhinoplasty.

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