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Considering a Brow Lift? Here’s what you need to know…

Perhaps you look tired, even when you aren’t, or maybe the aging process has caused unsightly sagging skin or the dreaded under-eye bags. No matter your reasons for considering a browlift, it’s important to know about the options available , steps your plastic surgeon will take, and the recovery period.

If cosmetic surgery is the way to go, talk to your cosmetic surgeon to learn more about your options and if you’re a good candidate for browlift. Your surgeon will explain the process and recovery to you.

Before your browlift procedure begins, your surgeon will study your facial structure, as different people exhibit slightly differing contours.

During the procedure, your surgeon will make incisions into the skin of your forehead to pull it into a more taught position. Dr. Pearlman feels that the endoscopic browlift is the best and least invasive for most patients.

After the typical brow enhancement procedure, there will be an approximate 2 week healing period during which time swelling and overall discomfort will diminish and surrounding skin in the brow area will begin to take on a smoother appearance. The result? More youthful looking skin and eyes and an appearance of energy and vitality over fatigue.

A browlift is a long lasting and proven method to look more youthful and has been proven safe time and again. Talk to and interview local cosmetic surgeons to learn more about this procedure and if it’s right for you.

Sometimes, even Botox can do the trick. By relaxing the muscles that pulls the brow down, some patients can get results that may be akin to a browlift.


Copyright 2012. As licensed to Pearlman Aesthetic Surgery. All rights reserved

Botox New York and Hollywood

Why do celebrities get such bad Botox?

New York, NY. One would think that Hollywood celebrities would have access to some of the best plastic surgeons and dermatologists, yet why do so many get such bad results? I am asked this question all the time by patients and don’t really have an answer. I have been recently quoted in,, and Star Magazine (see below) about Kate Gosselin and David Spade. Both have peaked eyebrows most likely from poorly performed Botox.


Over 10 years ago when we started treating areas other than the frown lines, Botox was injected in a “V” pattern up the forehead to smooth out horizontal brow wrinkles at the same time as relaxing furrowed brows or the “angry 11’s.” This left the sides of the foreheads with fully functioning muscles and patients sometimes got what we call the Mr. Spock or Jack Nicholson look. This was then treated with a few small dots of Botox to relax these remaining muscles. From that, we learned over a decade ago to include those latter areas into our original treatments. Very rarely now do we get results like those seen in these news stories.  So even if these celebrities had unusual reactions to the Botox, it certainly could have been corrected within days by a little more Botox.

I was quoted in Star Magazine (above) that David Spade had an over-done browlift. This was only part of the quote. I really said that he more likely had Botox and the reaction explained above. If he really had a browlift then it was certainly pulled way too high for a male. The male brow should be without a peak. See my article on the ideal brow. Steven J. Pearlman, M.D., F.A.C.S.

Teaching Facial Plastic Surgery in New York

New York, NY

I got a taste for teaching facial plastic surgery going back to my residency where I presented at a national meeting in front of hundreds of practicing physicians. One year and two other journal publications later, I was asked by my facial plastic surgery fellowship preceptor and mentor Dr. William Friedman to co-author two chapters for an upcoming textbook in facial plastic surgery.

  1. Friedman W.H. and Pearlman S.J., Preoperative Evaluation and Patient Selection for Blepharoplasty. Aesthetic Facial Surgery, Krause, C.J. ed. J.B. Lippincott Company. Philadelphia 1991.
  2. Preoperative Evaluation and Patient Selection for Rhinoplasty. Aesthetic Facial Surgery, Krause, C.J. ed. J.B. Lippincott Company. Philadelphia 1991.

I recall a lot of pressure to write something that was befitting sharing authorship with such a respected physician plus the knowledge that it will likely be read by thousands of peers. As a fellow, I rounded daily in the hospital with residents from Columbia Presbyterian Hospital. Thus began my academic career. Teaching is a big responsibility. It requires me to be on top of my game at all times. At rounds, answers to residents’ questions need to be precise and accurate. Teaching in the operating room requires comprehensive understanding of the procedure, background, reasons for all maneuvers and discussion of potential complications (and how to avoid them, of course).

Over the past 22 years in practice, I have authored over two dozen articles in peer reviewed journals (the most recent on revision rhinoplasty) and textbook chapters (the most recent on Endoscopic Browlift) and have given hundreds of lectures on various topics in facial plastic surgery. I now teach my own fellows as well as residents. Currently I have a fellow, Dr. Jason Moche, who is about to graduate. We are working on a combined project looking at revision rhinoplasty. I also have two ongoing research projects with residents on rhinoplasty techniques. So, if you want to find a surgeon who is on their toes and knows the latest about their specialty, look for those who teach.

Browlift and Botox in New York

The perfect eyebrows

New York, NY:

The perfect brow is club-shaped centrally then tapers along the tail with the center portion beginning at a vertical line drawn upward from the edge of the nostril. The tail extends to a line that runs  from the corner of the nose through the corner of the eye. The height of the brow should be equal at both ends; typically at or just above the rim of the eye socket. Generally, in women, the brow should arc delicately with the highest peak between the corner of the iris and the corner of the eye. The male brow should rest on or at the rim of the eye socket and is more horizontal in shape. Aestheticians commonly use the “pencil trick”* to guide them in eye shaping. The skin portion between the brow and the eye should be smooth and have a youthful fullness, with little excess skin and no over-hang of the skin. This leaves a nice platform to apply eye shadow without flaking or cracking.



Peak of brow
Peak of brow
Tail of brow

Tail of brow



All the above is well and good for teens and models, but as we age, the brow may flatten and droop as well as deflate. There are a number of non-surgical as well as surgical techniques to rejuvenate an aging eyebrow. Eyebrows can be elevated non-surgically by the use of expertly placed Botox. Not only can brows be lifted, but shaped as well. Crow’s feet can also be smoothed. Sometimes it’s more a deflation of the eyebrow instead of drooping. In that case, fillers such as Restylane or Juvederm can be used to restore youthful fullness that mimics a browlift but actually doesn’t lift the brow.

When is surgery necessary? When there is significant wrinkling and redundancy of the eyelid skin, which may be due to excess skin or drooping of the eyebrows. If the brows are in good position and the overhanging skin doesn’t extend far beyond the corner of the eye, a blepharoplasty is the best solution. When the excess skin goes well past the eye, that means that the brow has dropped; a browlift is more helpful. Another way to tell if it is the brows or eyelids that are the problem: if you look worried, sad or angry it’s more likely due to a brow problem. If you look tired it’s usually more from the eyelids. Another way is to pull out photos of yourself from your mid 20’s, and check where your eyebrows once were.

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