We are all familiar with the childhood skeleton song that helps teach about the interconnectedness of all the bones in the body. If you’re not, it goes like this: “the hip bone connected to the backbone, the back bone connected to the neck bone…” https://en.wikipedia.org/wiki/Dem_Bones
As a plastic surgeon, when patients come in for a consultation about having eyelid surgery to improve their appearance they are often surprised when I advise them that the eyebrow must also be addressed.
This is when I have to introduce a version of the skeleton song. It goes like this, “the forehead is attached to the eyebrows, the eyebrows are attached to the eyelids.”
I go on to explain that the relationship between the eyebrow and the upper eyelids is like the relationship of a curtain and a curtain rod. The eyebrow being the curtain rod, the eyelid, the curtain. If the curtain rod is bent, broken or saggy, the curtains are going to be sagging too. If the eyebrows are low or misshaped, simply removing skin from the eyelids will pull the eyebrows further down, creating an angry or sad look to the face.
Often, when discussing options with prospective patients, I use the curtain analogy in addition to talking about the lid platform, the area where women apply eyeshadow. The greater the eye shadow space the more open the eyes appear. The height of that space is determined by the height of the eyelid crease and how much excess skin and/or fat hangs over the crease. I realize the idea of a browlift can be overwhelming and sometimes frightening, but I encourage patients to think of it as stabilizing the brow, not so much lifting. Once the eyebrow, or curtain rod, is stabilized it allows for me to critically address the upper eyelids and make sure they are not only in the proper position, but the correct amount of heaviness is removed.
This is something to keep in mind if you are considering an oculofacial procedure. The most important first step is a consultation with an experienced board-certified surgeon.