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I had Botox injected in my forehead about two weeks ago, and now I can really see...

Q:

I had Botox injected in my forehead about two weeks ago, and now I can really see that I need an upper eyelift. Is it too soon to visit a surgeon? Do you have to wait for the Botox to wear off? Why do some doctors prefer a laser to a scalpel for eyelid surgery? Are the results the same?

A:

Your concern about the need for an upper eyelid lift or brow lift after receiving Botox injections to decrease forehead wrinkling is a common occurrence. As we age, the brow falls or becomes ptotic (sags), affecting the appearance of the upper eyelid. The eye appears smaller and you lose a highlight area lateral and below the eyebrow; this area is called the "frontal bar." The Botox probably helped get rid of the wrinkles on your forehead but caused your brow to fall due to paralysis of the frontalis muscle. As you probably know, this condition will not last since the effects of Botox are temporary. However, it is not too soon to discuss the options regarding cosmetic surgery, even though you have recently received Botox injections. Brow lifts are commonly performed today with endoscopic equipment requiring much smaller incisions than in the past. The eyelid area may require surgery due to too much skin or excessive fat. This operation is referred to as a blepharoplasty (cosmetic eyelid surgery). A laser is sometimes utilized in this procedure. It allegedly decrease tissue trauma and therefore should decrease postoperative swelling and bruising. Lasers are expensive and may slightly increase the cost of the procedure. The long term results are quite similar whether a laser or scalpel is utilized for this procedure. To find out what options would be most effective in your case, you should consult with a local plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery.

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