Key facts
- Three causes of a heavy lid
- Loose lid skin (dermatochalasis), a descended brow, or a weak levator muscle (ptosis)
- What HIFU addresses
- Brow descent, by firming the forehead and brow skin with shallow cartridges
- Depths used
- 1.5 mm and 2.0 mm over the forehead, brow and temple; deeper cartridges are not used here
- Kept away from
- The orbital rim and the eyelid itself; energy is never directed towards the eye
- Not a HIFU question
- True ptosis (lid margin sitting low), heavy skin redundancy, a brow heavy because of bone or fat
- Fee
- Set in writing after assessment; see how fees are quoted
Which heavy eyelid is a brow problem?
A heavy upper eyelid has three possible authors, and HIFU is relevant to one. Loose lid skin folding over an intact crease is dermatochalasis, a skin problem. A brow that has descended and is pushing normal eyelids down is a brow problem. A lid margin that sits low because the levator muscle that opens the eye is weak is ptosis, a muscle problem that is surgical. The non-surgical eyelid lift page describes how these are sorted; this page covers what HIFU does for the brow-driven kind.
The sorting is done by measurement and by watching. Dr Sin Yong measures the distance from the pupil's light reflex to the lid margin, looks at where the brow sits in relation to the bony rim, asks you to relax your forehead and sees whether the lids drop further, and lifts the brow gently with a finger to see whether the heaviness disappears. If it does, the brow is the author and firming the tissue that lets it settle is a reasonable aim. If the lid margin itself is low, no energy treatment on the forehead will change that.
Which depths are used around the brow, and why is the orbital rim avoided?
Around the brow the shallow cartridges are used: 1.5 mm in the superficial dermis and 2.0 mm a little deeper, across the forehead, the brow and the temple. The tissue here is thin and sits close to bone, so the deeper 3.0 mm and 4.5 mm cartridges used on the jawline have no layer to land in and are not used. Lines are placed across the forehead and along the upper border of the brow, firming the skin and the superficial layer that let the brow drift down.
The orbital rim is avoided and energy is never directed towards the eye. Focused ultrasound is a thermal injury at a focal point, and the structures inside the orbit are not tissue to be heated, so the lines stop at the bony rim and nothing is delivered on the eyelid itself. The supraorbital nerve emerges from the rim above the inner brow and the temporal branch of the facial nerve crosses the temple, and both are respected in the placement. The HIFU page describes the cartridge depths and how they are matched to tissue.
“Hooded skin and a weak eyelid muscle look alike in the mirror — they are different problems with different right answers.”
Dr Sin YongOn sorting droopy eyelids
Who suits HIFU for brow heaviness, and who should be assessed for something else?
HIFU suits a brow-driven heaviness in someone whose double eyelid crease is intact, whose lid margin sits at a normal height and whose brow lifts the heaviness away when it is nudged up with a finger. It is a modest, non-incisional option for the frame around the eye, and it keeps the crease exactly as it is. A systematic review of focused ultrasound for skin tightening notes that the brow was the first area in which a measured lift was reported.
True ptosis is referred: the levator muscle needs surgical correction, and no energy device reaches it. Heavy skin redundancy that folds onto the lashes is beyond what firming can address and is referred for blepharoplasty assessment by a plastic surgery specialist, with the double eyelid surgery comparison explaining what that involves. A brow that is heavy because of bone shape or a full brow fat pad is not a laxity question. Where the periorbital support rather than the forehead skin is the issue, the VF Periorbital Eyelift, which uses Volnewmer monopolar radiofrequency and no focused ultrasound, is the option described on the eyelid page, and fractional CO2 laser addresses thin, crepey lid skin itself.
What are the risks around the eye, and when should you call?
The risks around the brow come from nerves and thin tissue. Heat near the supraorbital nerve can cause a tender or numb patch on the forehead or a headache that settles; heat near the temporal branch of the facial nerve can weaken the forehead on one side for a time, so that one brow does not raise. Energy placed into the temple of a lean face can leave a hollow. Redness, warmth and tenderness over the brow are expected and settle, and slight swelling of the upper lid the next morning can occur.
A brow that does not raise, persistent numbness, marked or one-sided swelling, any change in vision or pain in the eye itself should be reported the same day. These risks are reduced, not removed, by using only the shallow cartridges, stopping at the orbital rim, respecting the nerve courses and adjusting energy to what you feel. The complication care page lists the signs that need prompt attention.
What else is considered for a heavy brow, and what determines the fee?
A heavy brow is often approached from more than one direction. Botulinum toxin to the muscles that pull the brow down changes the balance of the forehead and can let the brow sit a little higher; the VF Periorbital Eyelift firms the periorbital support with monopolar radiofrequency; fractional CO2 tightens the lid skin; HIFU firms the forehead and brow skin. Which of these applies, and in what order, follows from which of the three authors is responsible, and a heaviness that is mostly ptosis is sent to the appropriate surgical specialist rather than treated around.
The fee depends on the zones the examination calls for, whether HIFU is planned alone or alongside botulinum toxin or the VF Periorbital Eyelift, and how the plan is staged around review. Singapore's rules prevent clinics from advertising prices, so no figures appear here; a written quote follows the consultation, as the how fees are quoted page explains, and the consultation decides whether HIFU is the right tool at all.
