Eyebrows and Eyelids Blepharoplasty Browlift and Fillers NYC

woman with curly hair in a black sweater outside


New York, NY. Eyebrows frame the face and have been one of the most visible and changeable hallmarks of facial beauty over the past century. Beauty is defined by magazines and movies and not Plastic Surgeons. So when I want to demonstrate what the perfect brow looks like to a patient, I usually say “let’s look at a plastic surgery textbook” and then open a fashion magazine and flip through the ads and editorial pages.

Makeup artists and aestheticians have long understood what makes the perfect brow. The brow is club-shaped centrally then tapers along the tail. The central portion of the brow begins at a vertical line drawn upward from the edge of the nostril. The tail extends to a line that runs from the corner of the nose through the corner of the eye. The height of the brow should be equal at both ends; typically at or just above the rim of the eye socket. Generally, in women, the brow should arc delicately with the highest peak between the corner of the iris and the corner of the eye. The male brow should rest on or at the rim of the eye socket and is more horizontal in shape.

The skin of the upper eyelid should be smooth and have a youthful fullness, with little folding or wrinkling. Makeup artists love this since it leaves a nice platform to apply eye shadow without flaking or cracking.

All the above is well and good for teens and models, but as we age, the brow may flatten and droop as well as deflate. Before even considering cosmetic surgery, a skilled makeup artist can often shape your brows to restore a youthful arch.

How can we change the brow?

Eyebrows can be elevated and shaped non-surgically by the use of expertly placed Botox. Crow’s feet can also be reduced. Sometimes it’s more a result of flattening of the eyebrow instead of drooping. In that case, fillers such as Restylane or Juvederm can be used to restore youthful fullness. Using a filler to repair deflated eyebrows may work just like a brow lift but actually doesn’t lift the brow.

Eyelids or eyebrows?  If you look worried, sad or angry it’s more likely due to a brow problem; looking angry often responds to a quick Botox treatment.
If you look tired, it’s usually more from the eyelids. Another way is to pull out photos of yourself from your mid 20’s, and check where your eyebrows once were and maybe still are.

When is surgery necessary? When there is significant wrinkling and/or  folding of the eyelid skin and your eyeshadow won’t stay without flaking. Wrinkling of the eyelids is due to either aged skin, drooping of the eyebrows or both. If your eyebrows are in good position and the overhanging skin doesn’t extend far beyond the corner of the eye, a blepharoplasty (eyelift) is the best solution. When the excess skin goes well past the eye, we call that lateral hooding.  Hooding means that the brow has dropped; a brow lift is more helpful. Remember, when it comes to a youthful eyebrow/upper eyelid complex, its’ about shape not height.

Steven J. Pearlman, MD, FACS