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A 33-year-old woman has high and heavy brows. She wants to know if an upper blepharoplasty can improve her heavy eyelids. Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that upper eyelid blepharoplasty is a procedure that is focused on what is done under the skin rather than the skin itself. In this woman's case, he observed that she doesn't have a lot of extra skin and her eyebrows are already relatively high and in a good position. He thinks she doesn't need to entertain brow lifting at this point since the general trend nowadays is not having high arch brows like in the 90s. Patients with this type of situations, Dr. Prasad would let them look at themselves in the mirror, take photos and use a Q-Tip to roll the eyelid skin inward. This is an important assessment so that he can determine how much skin can be removed. Too much removal of eyelid skin may leave the patient with too little skin for the upper eyelids to comfortably close. There are two anatomic issues or concepts that a patient who wants to undergo eyelid surgery need to understand. One is about orbital fat. Orbital fat is the fat that's normally around the eyeball, part of it is inside the muscle cone and behind an anatomic feature called the septum, which may create some volume. The patient with this type of fat manifests deep set creases, and if they want a deeper crease, that's the place he would sculpt the orbital fat. Another area where fat is found is the sub brow fat. This is the fat that is found below the eyebrow adjacent to the orbital rom. The reduction of fat in this area will give someone more definition and solve the problem of heavy brows. Unfortunately, there are some surgeons who overdo these type of procedures and the patient ends up having hollow eyes. Upper eyelid blepharoplasty is an art and should be unique to every patient. Dr. Prasad suggests that she meet with qualified cosmetic surgeons and get their artistic sense. She should find someone who understands her concerns and who clicks with her and then she can move forward with the procedure. For more information, visit us in our website: http://prasadcosmeticsurgery.com/pras...