Dr. Sam Lam Plastic Surgery Forum

Dear Dr. Lam,

I stumbled across this article >> www.ncbi.nlm.nih.gov/pubmed/18827656
and am wondering if this is a suitable alternative to double eyelid surgery. If you lift the eyebrows by removing minimal sub-brow fat, can you make the eyes appear more open? I would just like your opinion on this since they are currently doing this procedure in Beijing and Seoul.

no, that won't work, it will just make your brow thinner (which ages you) and higher (which can make you look unnatural and is not needed). you need a crease. i hate browlifts and brow fat removals. they make me physically ill in 98% of the time and is particularly terrible in asians because the crease should not be too high and sculpted (not in whites but definitely not in asians).
best,
sml

Dear Dr. Lam,

Could you explain how it would ruin your brow? The eyebrow itself (hair and all) should sit in the same spot after the surgery since they would remove the fat directly underneath, correct? Also how would the brow be thinner. I'm worried because I think too much sub-brow fat is likely to droop with time and cause hooding.

I'm in my 20's and I found this procedure attractive only because I'm nervous about a doctor operating so closely to my eyeballs.

I do have a tiny crease. It's just that I have so much eyebrow fat that it covers the crease, if that makes any sense. (For example, if I do not look directly towards you but upwards, a crease can be seen).

Also how do brow lifts make you physically ill? Is it harder to heal?

Dear Dr. Lam

Sorry I wanted to add one more thing. I actually downloaded the entire article. I hope it's safe to just cut and paste only relevant parts of the article:

Not Wanting to Violate Inborn Natural Lid Crease Lines


Many patients who have inborn lid crease lines from youth experience gradual concealment of the lid crease line as aging progresses. This is especially evident in the Asian population, where the tarsal plate and lid crease heights tend to be small, so that apparent fold height decreases with age. With the infrabrow excision blepharoplasty, this concealed fold becomes apparent and thus reanimates the eyelid conformation of the individual at youth. No other lid crease surgically created at this age matches the revived natural lid crease line.

If you subscribe to Ovid the article is completely free if you are interested. Otherwise, thank you so much for looking into it. I thought I'd get an opinion from several American surgeons.

Anyways I totally respect your advice and I will research more into it. It does seem like a risky procedure, but I have been receiving mixed opinions about it from several plastic surgeons.

first, i do not know about it well enough to really comment so i should abstain from saying it is good or bad, but here are my thoughts.
1. we tend to LOSE fat of our brow as we get older, making the brow look deflated and start to sag. most surgeons cut fat out and lift brows upward that make the high hollower in appearance. this may not be an issue for you in the next 5 to 10 years but it becomes one when you get older. read this article i wrote about my understanding of aging of the upper eyelid and brow in all races:
http://www.lamfacialplastics.com/resour ... -tutorial/
2. even for asians, i rarely if ever remove fat. how is that possible when the eyelid looks so puffy? the reason that i do not remove eyelid fat in about 80% of asian eyelid procedures is that it will create unnatural hollowing in one's late 30s and beyond. i believe that the fat slides down the levator onto the edge of the eyelid making the eyelid appear fuller and lower. all you have to do is to make the crease to reposition the fat higher so that it does not cause the eyelid to look so full and low. read this tutorial that i wrote to understand that concept better:
http://www.lamfacialplastics.com/resour ... -tutorial/
hope that helps a bit. if not, it is very hard to have a layperson understand the anatomy well enough.
best,
sml