Eyebrow ptosis and browlift for paralysis frontalis muscle Coronal Brow Lift for Eyebrow Ptosis (drooping brow)

A ptotic (drooping) eyebrow can make the upper eyelid interfere with vision. Brow lift surgery may be needed for non-cosmetic problems. Explore the eyelid for both reconstructive and cosmetic (blepharoplasty / browlift) surgery.

Michael Bermant, MD
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Eyebrow ptosis and drooping eyelid from frontalis muscle paralysis and brow lift surgery
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Coronal Brow Lift
to correct Eyelid and Brow Ptosis (Drooping) from Partial Paralysis of Left Brow (Brow lift, forehead lift)

The eyebrow tends to sag or droop with age. The brow is suspended with the forehead muscles (frontalis muscles). Paralysis of the frontalis muscle will lower the brow. If only one side is paralyzed, the brows will be asymmetrical (unbalanced).

Partial Paralysis Brow with Ptosis Upper Eyelid
Eyebrow ptosis and drooping before browlift surgery

This black and white photograph is of the patient trying to raise her brows. The right brow elevates. The paralyzed left eyebrow does not move well. The droopy tissues can interfere with vision.

Eyebrow ptosis before brow lift surgery

The upper eyelid drapes over the eye to protect and help keep the surface moist. Closed, the eye may be protected but you cannot see very much through the eyelid. To see you must lift the upper lid out of the way. The levator muscle performs most of the work to get the upper eyelid out of the way for vision.

The levator muscle works well when not challenged with an additional work load. The eyebrow position on the forehead creates the starting point for upper eyelid function. If the brow is too low, the levator cannot lift the eyelid satisfactorily.

Ptosis of the eyelid means that it droops too low and cannot get out of the way enough for the eye to see. Elevation may be just enough for gaze towards the lower visual fields (towards the feet). Looking straight ahead, the lid may obstruct vision.

Partial Paralysis Brow with Ptosis Upper Eyelid

Eyebrow droop or ptosis before browlift surgery Eyebrow droop or ptosis after browlift surgery

Eyebrow ptosis before brow lift surgery

No more ptosis after brow lift surgery

This patient suffered damage to her left frontalis muscle resulting in the left brow drooping. She was able to compensate. In this patient, the upper lid covers half of the pupil. This patient compensated with her eyelid (levator) muscle. As she became tired, the muscle fatigued obstructing her vision from that eye. Notice how the upper eyelid is pushing against the lashes. On direct gaze the eyelid muscles can keep the pupil unobstructed. These pictures were taken early enough in the day that the patient could keep vision clear.

Partial Paralysis Brow with Ptosis Upper Eyelid
Brow droop or ptosis before brow lift surgery Brow droop or ptosis after brow lift surgery

Eyebrow ptosis before brow lift surgery

No more ptosis after brow lift surgery

When looking up the levator eyelid muscle can only compensate to uncover 1/2 of the pupil of the left eye before surgery. The brow could not be moved high enough to prevent a drooping eyelid.

Partial Paralysis Brow with Ptosis Upper Eyelid

Upper eyelid drooping from frontalis muscle paralysis after browlift surgery. Upper eyelid drooping from frontalis muscle paralysis before browlift surgery. Lazy or droopy upper eyelid from frontalis muscle paralysis after brow lift surgery. Lazy or droopy upper eyelid from frontalis muscle paralysis before brow lift surgery.

Eyebrow ptosis before brow lift surgery

No more ptosis after brow lift surgery

Eyebrow ptosis before brow lift surgery

No more ptosis after brow lift surgery

Notice how the left side view is much different than the right before surgery. The hooding of the upper left eyelid is obvious before surgery. After the coronal brow lift the patient no longer had to make the levator eyelid muscle work as hard to uncover the eye.

Surgical correction was with a coronal brow lift. An incision is made in the scalp behind the hairline. The skin and tissues are dissected to just below the brows. Symmetry was reestablished by dissecting the left more extensively than the right. The redundant tissue is removed and then the scalp resutured together.

Back Eyelid Ptosis - droopy upper eyelids.Forward Eyelid Ptosis - droopy upper eyelids.

Other topics of interest:

Ptosis of the eyelid (dropping of the upper eyelid).
Upper eyelid ptosis and drooping eyelid.
Ptosis classification 
Muscle function and dysfunction in drooping eyelid problems.
Upper eyelid ptosis with frontalis muscle compensation.
Measuring eyelid function in eyelid ptosis.
Testing levator muscle for drooping eyelid
Congenital eyelid ptosis reconstructive surgery options. 
Recurrent congenital eyelid ptosis in a 26 year old black male.
Frontalis muscle compensation in drooping eyelid
Ptosis associated with paralyzed eyebrow muscle.
brow ptosis creating droopy eyelid
Ptosis associated with Blepharophimosis (congenital eyelid deformity).
eyelid ptosis
Blepharoplasty (Cosmetic surgery of the eyes)
eyelid

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