I would not do surgery yet, but consider Botox for now

James F. Boynton, MD answers: Am I a good candidate for a brow lift and upper blepharoplasty surgery?

I have just turned 35 and noticed that my eyes are starting to look old. My eyebrows have dropped slightly and my upper eyelids always look tired and little puffy no matter how much I sleep. I have also noticed that my eyes no longer look as open and have the nice almond shape they had when I was in my 20's. So I would like to know if a brow lift combined with a blepharoplasty would be the right procedures to fix the problems I just mentioned or would just a brow lift by it self be sufficient?


James F. Boynton, MD
6 months ago

Based on your analysis of your photo and your age, I would not recommend surgery at this time. All of us age at different rates, but it is a bit unusual (but not impossible) for patients to need Blepharoplasty in their 30s. In my practice, it is much more common in the 40s.  

I have no doubt that you have seen some changes in aging (as we all do), but I still think it's premature for an upper lid blepharoplasty. When I look at your photo I see some mild brow descent and a loss of "upper eyelid show". This can be caused by dermatochalasis (excess crepy upper eyelid skin) and/or brow descent.  In your case I think it seems to be brow descent. 

I think you're a perfect candidate for what I call a "Botox Brow Lift".  I would recommend Botox injected properly in the glabella, the central forehead, tail of lateral eyebrow, and "crow's feet area". This will rejevenate the upper face and give you 1 to 2 mm of lift back to your eyebrows, as well as give the appearance of a brighter less tired eye as some upper eyelid show is restored. Sometimes it is necessary to add filler such as Restylane to the lateral brow as a strut to help aid in this lift.

Patients in their 30s and with your minimal rhytids (skin creases) respond extremely well to Botox Brow Lifts.

If this is unsuccessful in giving the lift you need to the brow, then at some point I would probably recommend an endoscopic brow lift only which would only place small incisions in the hairline and give some lift and the restoration you desire.

I have no doubt at some point (maybe in 10 years) you may come to need a blepharoplasty but I would wait as there can be problems removing too much upper eyelid skin when it is not warranted.  

I hope this helps!

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