Crepey Skin

When performing upper blepharoplasty, simply removing extra skin is not enough to create a desirable outcome.  Successful blepharoplasty requires what Dr. Steinsapir calls a ‘structured’ blepharoplasty.  It is essential to properly support the upper eyelid skin to avoid crepey upper eyelid―platform skin that simply won’t hold makeup.  To correct this problem, your surgeon will need to remove skin from below the upper eyelid crease and anchor the eyelid platform skin and underlying muscle to the levator tendon, which raises the upper eyelid.  This places the upper eyelid skin on a slight stretch resulting in a smooth platform for makeup.

An experienced and skilled surgeon can address crepey upper eyelid skin after unsatisfactory upper blepharoplasty with a carefully planned excision of the excess skin left on the eyelid platform.  With the eyelid open, the upper eyelid skin is anchored to the levator tendon to create a long lasting adhesion to the eyelid elevator.  Recovery is usually somewhat shorter than standard upper blepharoplasty.

An anchor blepharoplasty is an important part of any comprehensive eyelid surgery. This part of your procedure specifically addresses loose skin and drooping eyelashes on the upper eyelid platform.  Excess, wrinkled or loose skin here can give you a tired appearance associated with eyelash ptosis and crepey eyelid platform skin.

While ideally anchor blepharoplasty is a part of every blepharoplasty, unspecialized or less skilled surgeons may not be comfortable offering this important aspect of treatment.  Anchor blepharoplasty is a very technical skill that requires great precision and specialized expertise.  Without great experience, education and an artistic skill, your cosmetic doctor may have difficulty performing an anchor blepharoplasty as part of your upper blepharoplasty; unfortunately, in these cases you may find yourself disappointed after you heal and wish your eyes appeared more alert.

Heavy eyelids

Heavy eyelids following upper blepharoplasty are often the result of a pre-surgical condition that your surgeon failed to address during you consultations.  Before you underwent blepharoplasty, you presumably already had heavy lids and heavy brows.  The brain compensates for the heavy eyebrow by activating the frontalis muscle, the forehead elevator.  The forehead lifts the eyebrow until the skin in the upper eyelid no longer rests on the upper eyelashes.

Clinically, this situation can be detected by looking for lines in the forehead and an abnormally elevated eyebrow.  When upper blepharoplasty is performed in this setting, the excess skin in the upper eyelid is removed. This reduces the amount of forehead muscle activation that is needed to keep the upper eyelid skin off the upper eyelashes.  The forehead relaxes and the eyebrows come down. The net result is that it appears that almost nothing was done surgically.  Of course the forehead is smoother but if the objective was to make the eyes brighter by clearing space above the eyelashes, the net effect can be disappointing.  Under these circumstances the best option is to perform a forehead lift in conjunction with the eyelid surgery.

About Dr. Steinsapir

Dr. Steinsapir is on active staff at the UCLA Hospital and Medical Center at the David Geffen School of Medicine as an associate clinical professor of Ophthalmology in the Division of Orbital and Ophthalmic Plastic Surgery. UCLA is consistently rated the best hospital in the West and ranked at the top with a handful of medical centers in the United States. Many surgeries are performed on an outpatient basis at the Surgery Center at the UCLA Medical Center.  Dr. Steinsapir addresses a broad array of oculofacial reconstructive concerns.  Contact us today to schedule a personal consultation with Dr. Steinsapir.

Different types of forehead surgery

There are three major types of cosmetic forehead lifts; endoscopic, also called closed forehead lift, open forehead lift, and thread, or suture lift.  Of these three types, endoscopic forehead surgery is the safest, most effective, and most natural-appearing surgical solution.  Both the open and closed forehead lifts are long-lasting, with the open forehead lift showing no clear advantage in any area and some clear disadvantages.  Healing time for the endoscopic forehead lift is about five times faster, so you’ll see improvements sooner, and your risk of forehead lift complications is greatly reduced.

The thread lift, or suture lift is often advertised as a cheap alternative to the facelift.  The thread lift is a procedure in which a barbed suture is threaded through the face.  This is supposed to lift the face with minimal surgery.  It costs less than a facelift, and sometimes recovery time is shorter, but this procedure doesn’t last and can have associated complications.  Most cosmetic surgeons do not perform thread lifts because they feel that they are ineffective.  For cosmetic purposes, Dr. Steinsapir primarily performs endoscopic forehead lifts, or closed forehead lift.  The endoscopic forehead lift offers many advantages to other alternatives.

Where is surgery commonly performed?

A forehead lift, whether open or closed is a surgical procedure and cannot be performed during an in-office visit.  Surgery is typically performed in an outpatient surgery center.  Dr. Steinsapir performs this procedure at the UCLA Outpatient Surgery Center where he is on staff as an Associate Clinical Professor and Attending Surgeon.  An endoscopic forehead lift requires intravenous sedation but general anesthesia is typically not needed.  This means that you have surgery with minimal drug exposure contributing to a faster recovery.

What is the typical recovery course and physical restrictions?

Swelling and bruising following an endoscopic forehead lift can last for several weeks.  However, most women find that after 7 to 10 days and a little makeup, they can go out and about without calling attention to themselves.  Most men find they can return to their work routine without makeup at 7 to 10 days.

Endoscopic forehead lifts involve a relatively short recovery process and patients usually experience minimal discomfort.  Smaller incisions mean less healing and a faster recovery and is associated with few complications compared to the open forehead lift technique.  Numbness of the scalp, which was universal with the open forehead lift, is rare with the endoscopic forehead lift.  There is very little if any hair loss with a small incision forehead lift.

What are some common complications and how are they addressed?

An endoscopic forehead lift offers faster healing time and fewer negative effects like scalp numbness, hair loss, or a long scar.  Although a few who insist on continuing to perform the open forehead lift may say that the resulting scar from the open forehead lift can be “hidden” underneath your hair, the reality is that this breaks up the natural hair growth pattern.  The untrained eye will recognize that something looks slightly “off” about your hair line―even beveled incisions that allow some hair to grow through the scar can look wrong.  In hair grafting circles, this is referred to as “compression.”  Natural hairlines do not have compression.  Many who have had this procedure also do not like the long term numbness that results from cutting large sensory nerve in the scalp.  The open coronal forehead lift can also be associated with permanent hair loss along the incision line.  These complications are not seen with the small incisions used for the endoscopic forehead lift.

What is the time frame before full recovery?

Following endoscopic forehead lifts, the forehead needs to be supported while the body heals.  This support is called brow fixation and there are several options for brow fixation.  The two most common options in this practice are the Coapt endobrow Endotine or microscrew fixation.  The Coapt device is a small plate that is used in pairs.  The plate is fixed to the forehead bone and supports the forehead.  The device is completely covered and over time will dissolve.  The other method for supporting the forehead after surgery involves three or four small microscrews that poke out of the scalp.  A small staple behind each post supports the forehead.  The posts and the staples are removed about three weeks after surgery.  Again, these are hidden in the hair and are generally not noticeable to others.  Dr. Steinsapir allows a return to the gym in 10-14 days, however even the day after surgery you will be encouraged for go out for a walk.  Most find that they can resume business by telephone, email, and computer the day after surgery.

Is Dr. Steinsapir available for a personal consultation regarding this surgery?

Dr. Steinsapir believes strongly that there is not substitute for a personal consultation to determine if a particular surgery is right for you.  Dr. Steinsapir performs this consultation himself so he can get to know your medical history and personal concerns.  He will perform a detailed examination.  After assessing the totality of your personal situation, he will discuss with you his opinions, concerns, and recommendations.  This will include a through discussion of risks, benefits, alternatives, and likelihood of success.  Call today for your personal consultation.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

I already have permanent makeup, can I have eyelid surgery?

If you already have permanent makeup, this won’t prevent you from having eyelid surgery.  Generally the permanent makeup is placed within the eyelashes and eyelid surgery typically does not require an incision along the lashes.  Occasionally, the permanent lower eyelid makeup extends beyond the lower eyelid lashes.  The portion of the eye line that extends beyond the lower eyelid lashes may be affected by lower eyelid surgery, but a skilled surgeon can work around this issue and many lower eyelid procedures do not require a lower eyelid incision.

I have permanent eyebrow makeup, can I have a facelift?

Permanent makeup for the eyebrow generally fills-in or darkens your existing eyebrows.  As a result, a forehead lift that moves the eyebrow will also cause your permanent eyebrow makeup to move.  Occasionally, a woman has plucked her thin eyebrow hairs and penciled in a brow at a higher location.  Before considering having this eyebrow location marked permanently with a tattoo, Dr. Steinsapir recommends a cosmetic consultation.  In some cases, an endoscopic forehead lift may correct the location of your eyebrows and improve your appearance and make your eyebrows appear more natural.  For this reason, before you have your eyebrows tattooed in a higher location, consider having a surgical consultation for an endoscopic forehead lift.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

The benefits of a forehead lift

In some instances, a forehead lift alone can freshen your face and provide you with the youthful appearance you are seeking.  The forehead lift elevates the eyebrows, reduces frown lines, and smoothes your forehead.  Eyelid surgery deals with the height of the crease, the crease structure, and eyelid and lash ptosis.  Although this can freshen your look as well, the forehead lift addresses one of the focal points of your face – one that can make the difference between looking tired and run down and looking youthful and refreshed.

A forehead lift can freshen your appearance

Dr. Steinsapir only performs endoscopic forehead lift, or closed forehead lift, as opposed to the more traditional open forehead lift.  The endoscopic forehead lift offers faster healing time and fewer negative effects like scalp numbness, hair loss, or a long scar.

The benefits of a lid lift

Blepharoplasty, also known as eyelid surgery or a lid lift, allows the surgeon to remove excess skin and fatty tissue that create the appearance of droopy, deflated eyelids.  As the fat deposits, loose skin, and drooping of the eyelids typically occur because of aging, this procedure can reverse the effects of time to restore a youthful, refreshed, and rested appearance.  Upper eyelid surgery, because it is a versatile procedure, can also accomplish other goals, such as creating an upper eyelid crease.

How will the surgeon know which procedure I need?

The primary issue in determining whether you need a lid lift, forehead lift, or both is the type of eyebrow support and shape you need.  Some individuals need just a forehead lift.  Your surgeon will assess the need to address upper eyelid issues.  In some instances people will have both eyebrow ptosis and excess upper eyelid skin and fullness and benefit from both sets of issues being addressed at the same time.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers, and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiply revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is board certified in Ophthalmology and multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Beverly Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.  Please contact us today to learn more about evidence-based treatment options with Dr. Steinsapir for proven results.

Endoscopic Forehead Lift Before and After

Some excuse this scar because it can be “hidden” under the hair, but the problem here is that the human eye and brain are amazingly capable of discerning the unnatural patterns of hair growth that result from this surgery.  Even with a carefully designed, beveled incision through the hairline’s edge that allows hair to grow through the scar, the eye perceives something amiss.  The hair is not as dense here, and for those opting for micrografted hair in this area, be warned that the uncontrolled compression and lack of random placement is easy for the eye to notice.  Lacking the relevant technical experience, others may not be able to describe what they are seeing, but they will think to themselves that something isn’t quite right about your hairline.  Those in favor of open forehead surgery argue that it is superior because it doesn’t push back the hairline.  However, it is nearly always better to push the hairline back a tiny five milimeters than to have an altered hairline and huge scar that even the best of surgeons cannot render natural in appearance.

The results of an endoscopic forehead lift last just as long as the open forehead lift, with the added advantages of faster healing, no hair lass, an extremely low risk of numbness, and no visible scarring.

What’s the difference between an open and closed forehead lift?

In short, the open forehead lift places the hairline slightly lower but creates an unnatural-looking hairline.  The endoscopic or closed forehead lift places the hairline subtlely higher while retaining a natural pattern in the hairline.  The endoscopic forehead lift offers faster healing time and far fewer complications because it is a minimally invasive technique, whereas the open forehead lift can be categorized as oversurgical.  Recovery from the endoscopic forehead lift is 5 times faster than the open forehead lift.  The endoscopic forehead lift presents a larger learning curve for surgeons and takes longer to perform until mastered, so some have been resistant to transitioning to this superior method.

How long does a forehead lift last?

As with any cosmetic surgery, an endoscopic forehead lift will set back your aging clock, restoring and extending a youthful appearance, but it cannot completely stop the clock, and gravity and sun exposure will continue to affect you.  You can expect your results to be long lasting and benefit you for five to ten years after surgery.  Even when the effects start to diminish, you can be guaranteed that you’d look much worse had you never undergone this procedure.  Thus an endoscopic forehead lift can be seen as twofold in purpose: it immediately improves the aesthetic appearance of your face, and it prevents you from looking excessively aged in the future.

Am I a candidate for an endoscopic forehead lift?

As we always say, only a personal consultation can tell you for sure, but some good indications of requiring a forehead lift are heavy brows, deep-set or hidden eyes, and wrinkled or sagging forehead skin.  In some cases Microdroplet™ BOTOX® treatment or eyelid surgery may be more appropriate, as each of these procedures can affect similar areas.  This really depends on the severity of your issue and other individual circumstances.  The only way to know for sure is to obtain an individualized consultation from a highly qualified cosmetic surgeon who will examine you and then talk with you about your goals and concerns.

If you had a forehead lift years ago and the effects have worn off, you can receive another if a consultation with a qualified doctor demonstrates that one is necessary.  Even if your last forehead lift was coronal, you may still benefit from a closed forehead lift today.

We cannot overemphasize the fact that what is best for one person may not be best for you.  While reading reliable information is certainly beneficial, it can never replace the advice obtained from a face-to-face appointment with an actual doctor.

How can I find a doctor who performs endoscopic forehead lifts?

You must directly ask potential surgeons if they perform endoscopic forehead lifts.  Also be sure to inquire as to which they perform – open or closed forehead lifts.  If they routinely administer the open forehead lift, you should be suspicious.  There are a very few exceptional situations for which the open procedure is most appropriate, but the best surgeon will tell you that these cases are rare and that he or she provides many more closed than open forehead lifts.  Find a surgeon who recognizes the superiority of the effective, minimally invasive closed forehead lift.

Dr. Steinsapir is such a doctor who understands the importance of administering an endoscopic forehead lift instead of a coronal one.  He constantly seeks solutions that involve minimal down time, maximum comfort, and the most natural results for his patients.  Dr. Steinsapir’s forward-thinking leadership is not new – in fact, he has been a lead performer of the small incision endoscopic forehead lift since 1990.  People from Beverly Hills, Los Angeles, and all over the world routinely travel to his practice to receive the best cosmetic eyelid and forehead treatments available.  Contact us today to schedule a consultation and have your questions and concerns addressed with honesty, care, and expertise.