Patient with heavy fullness on temporal side of upper eyelid despite adequate brow height.
Brow fat pad (yellow overlay) has descended into the eyelid causing the fullness.
1. From within the blepharoplasty incision, the skin is retracted upward exposing the offending dropped fat.
2. The capsule around the fat (anterior leaf of the deep galea) has been opened and the brow fat pad is being thinned (forceps holding free edge).
Excised brow fat shown on skin overlying its previous location
The remaining brow fat pad is now lighter (due to thinning) and more
mobile (due to releasing the galea) and thus easier for the
forehead muscle (frontalis) to elevate.
Browplasty is often included as a part of upper blepharoplasty and allows for additional debulking of tissue without excessive removal of eyelid skin and orbital fat and/or extensive forehead incisions.
Although used infrequently, browplasty may be combined with browpexy through the same blepharoplasty incision to not only thin the brow fat but also perform an internal suture lift for added support and stabilization in more advanced cases or in instances of facial paralysis.
Main Surgical Approaches