The question raised is a great one. As usual, the answer really depends on the patient.
Upper eyelid Blepharoplasty is designed to remove skin from above the upper eyelid crease to help the define the crease and highlight the shape of the eye. If done without a brow lift, the distance between the lash line and eyebrow is made smaller, therefore pulling the brow position down to some degree. This is not necessarily a bad thing, but an aesthetic change that may not be appealing to some patients.
A female brow lift, in my opinion, should allow for lateral elevation of the brow enough to create a relaxed look. It should also allow for a more relaxed central brow area (glabella ) via manipulation of the central brow muscles. There are few things that are more stigmatic of facial cosmetic surgery than an overdone brow lift; this is one of the greatest concerns for my patients seeking rejuvenation for the upper third of the face. Male brow lifts are less common for a variety of reasons. When indicated, the male brow should be raised in an even fashion. Over elevation of the central brow leads to a quizzical look ("The Bob Dole look") and should be avoided.
In female patients seeking facial rejuvenation, I feel that the combination of upper eyelid Blepharoplasty and brow lift (endoscopic or trichophytic) leads to a more harmonious result. However, this is not a hard and fast rule. It can be entirely appropriate to perform either upper eyelid Blepharoplasty or brow lift in isolation.
