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Brow vs bleph? Lift the brow and/or the upper eyelid with plastic surgery

Blog post - before after photograph upper eyelid surgery forehead lift brow

Women and men typically start to consider upper eyelid surgery due to natural aging in their 40’s. While some patients may benefit from eyelid surgery at an earlier age, patients more commonly have upper eyelid area surgery after age 40.

An upper blepharoplasty (i.e eyelid surgery) removes excess skin and fat from the top eyelid, but does not directly change the eyebrow. A brow lift lifts the eyebrow, primarily from the sides of the brow but may also improve the area closer to the nose too. For some patients, a brow lift alone may help improve the appearance of the upper eyelid without blepharoplasty. For others, a upper blepharoplasty combined with brow lift surgery is performed at the same time for facial rejuvenation.

How does a patient decide on whether a brow lift, upper blepharoplasty, or both procedures is the more appropriate option for them?

Upper eyelid surgery

Upper blepharoplasty is probably one of the most common cosmetic surgery procedures performed by facial plastic surgeons. Upper blepharoplasty is a relatively minor procedure that is performed via local anesthesia, which we previously reviewed here. Upper eyelid surgery takes about an hour and has minimal recovery. Upper blepharoplasty often removes skin, but may also lift muscle and reduce eye fat too, as appropriate. Below is an example of a woman who had upper eyelid surgery via local anesthesia. She looks naturally refreshed and is very happy with the results.

Upper eyelid surgery - before:after.001

Limited incision brow lift
Unlike traditional brow lift surgery from years ago that involves an incision across the entire forehead, the endoscopic or limited incision brow lift is a minimally invasive technique of lifting and stabilizing the eyebrows. Plastic surgeons perform minimally invasive plastic surgery through very small incisions hidden in the scalp hair for a refreshed appearance. Brow lift surgery lifts, repositions, and stabilizes sagging upper eyelid area tissue that occurs with natural aging and sun damage.

Limited incision brow lifts or endoscopic brow lifts (i.e. endobrow) usually takes under an hour via local anesthesia with IV sedation. Skin is not removed with this type of brow lift. By lifting the eyebrow, less redundant skin is in the upper eyelid area.

The woman in the photograph below had upper eyelid surgery several years ago. She was not a brow lift candidate initially during the eyelid surgery, but she continued to age naturally with time. She later underwent an endoscopic or limited incision brow lift to further improve the upper eye area, years after upper eyelid surgery. No incisions were placed in the upper eyelid, and no skin was removed to rejuvenate the upper eye area.

Benefits of an endobrow or limited incision brow lift, as compared to traditional brow lift surgery:

  • smaller incisions
  • reduced scarring, bruising, bleeding, swelling, numbness, and hair loss
  • faster recovery

Blog post - before after brow lift forehead plastic surgeryCombined upper eyelid surgery with limited incision brow lift
Generally, brow lift surgery and blepharoplasty are performed at the same time if necessary. One benefit of combined surgery is only going through one recovery period rather than two separate recovery periods. The other benefit of combined surgery is that for some patients the eyebrow may drop lower after upper blepharoplasty alone unless it’s stabilized or lifted with a limited incision brow procedure.

Below is a woman who always had low set eyebrows that worsened with time. In addition, she developed excess skin and a droopy upper eyelid. She wanted to rejuvenate the appearance of both the eyes and eyebrow. She underwent both upper blepharoplasty and brow lift surgery, as she would have had unsatisfactory results if she only had either procedure alone.

Blog post - before after photograph upper eyelid surgery forehead lift brow

If I can’t do both at the same time, which should be done first, upper blepharoplasty or brow lift?

Some patient are unable to or don’t want to perform both procedures. If performed separately, many plastic surgeons may recommend performing the upper eyelid surgery first, then followed by brow lift at some point in the future, perhaps combined with a face lift or other procedure. There isn’t one right answer, as each patient is unique. The decision to which procedure to perform first is determined by office examination and consultation with your plastic surgeon.

Are there alternatives to actual cosmetic surgery?

Yes, but non-surgical treatments to lift the eyebrow are more often temporary with more subtle results. Botox®, Dysport®, and Xeomin® are office treatments that not only soften wrinkles in the forehead, but may also improve the upper eyelid area by lifting the brow. These cosmetic injections must be performed every few months to maintain results.

In addition, there are “skin tightening” devices that use energy (ex. heat or ultrasound) to “lift” an area. The results with these non-surgical devices develop gradually with time and are also subtle, for those who may appreciate results.

How does one decide?
The decision for plastic surgery is a mutual decision between patient and plastic surgeon. Based on physical anatomy and patient preferences (cost, recovery, anesthesia, etc), the plastic surgeon will suggest an appropriate option for the patient to consider.

Plastic surgery of the eyes is very popular to improve one’s appearance. – Houtan Chaboki, MD

Have you thought of upper eyelid or brow plastic surgery? Share your questions below.

2 Responses to Brow vs bleph? Lift the brow and/or the upper eyelid with plastic surgery

  • Mary Hope Jenczewski says:

    Thank you for referring me to this article. I recently posted a few pictures regarding this very issue of whether I should get a Blepharoplasty, brow lift, or both. Your article was very helpful in explaining what each surgery is meant to accomplish and who may benefit from one, the other, or both. The general consensus from the feedback I received was that my brows are in an appropriate/attractive position. I never had an issue with my brow position; however, my increasingly drooping eyelids prompted me to do some research on excess skin removal which ultimately introduced me to the idea of the brow lift being considered a “2 in 1” type of surgery, meaning it could raise the eyelids and the brow with just one procedure.

    After posting my recent question and receiving several responses, I finally have a very good idea of what I need. I am extremely impressed with your work and although I haven’t called for a consultation yet, I feel like all of my concerns and fears of choosing the wrong Doctor have disappeared (so, you will be hearing from me soon 🙂 I have always had excess eyelid skin and it runs on my father’s side of the family. I am 42 and have noticed that when my eyes are open, the skin is folding lower than it did several years ago. I can literally feel the skin on my lid, it is heavy, and I feel like I am straining to keep my eyes open at times.

    I work with computers all day and have noticed the straining has caused me to use my forehead muscles more, which had begun causing some fine lines on my forehead over the eyes, not even in the mid-forehead. So, I began getting Botox injections 2 years ago. That helped the wrinkles, but is not addressing the underlying issue which I now realize is the heaviness of the excess eyelid skin. So, thanks to some online advice from doctors, others, and my own research, I am relieved to finally know which surgery is best for the natural outcome I am looking for.

    I have always been a very attractive, but natural person. I wear very little to no make-up most of the time. I would say my biggest concerns are some of the issues I’ve seen with botched surgeries. First of all, I have noticeably more loose skin on my right eyelid. When I have both eyes closed and go to open them, many times my left eye opens right up while my right eyelid is literally stuck from the fold that is basically “grabbing” onto my eyelid skin underneath. This feels very strange and was scary when I first felt it happen a couple of years ago. Because of this, I am assuming my surgeon (who will hopefully be you) will draw the areas to be removed very differently for each eye. I have a fear of too much skin being removed and not being able to close my eyes as I’ve heard of some horror stories about this. I watched a video of the surgery and noticed a ton of fat was being removed from the patient’s eyelid. I was wondering why? I am not the doctor, but I can’t imagine I would need a lot of fat removed. It would seem that removing too much fat would cause a sunken in eye look. That would be awful. My last concern is the potential of the surgery actually pulling down the brow and lowering it permanently. My brows are in medium-low range but fit my face. I just want them to stay where they are. Like I said, I am looking for a natural appearance. My goal is to have the excess skin removed, leaving a well-rested and rejuvenated appearance. I do not want to struggle anymore feeling like I am lifting weights with my eyes. I am looking forward to having the procedure within the next 6 months to a year at most.

    Thank you again for your article and the feedback you provided on my general question about whether I should go for a brow lift or Blepharoplasty. I’ve been very thorough with my research as I take this very seriously. It’s surgery after all. I hope to be able to take the time off from work in the next few months.

    • Houtan Chaboki, M.D. says:

      Thank you for reading our article, and we’re so glad you’ve found it useful! The brow vs. bleph issue can be confusing, and opinions will vary among plastic surgeons.

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    Houtan Chaboki, M.D.