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?
Am I a Good Candidate for a Brow Lift and Upper Blepharoplasty Surgery?
Doctor Answers 9
Early for browlift
The level of the brows in the picture is indeed slightly low. Sometimes it is best at age 35 to just perform the upper blepharoplasty. A browlift can always be done later; however, it is important that the brows are not lifted too much, which would give a surprised look
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I would not offer you surgery
Looking at your face (what you included of it) I can only assess you to be a youthful looking male. You have a sharp supratarsal fold with relatively normal positioning of your brow relative to your superior orbital rim. Your skin looks healthy in the picture. All of these are limited assessments but they point to you being probably better for minimally invasive procedures like Botox or injectible filler.
Surgery in the periorbital area carries significant risk so the need for the enhancement needs to be obvious. I agree with those who mention BDD, which stands for Body Dysmorphic Disorder. You need to look at your issues with your eye/brow critically and determine how important to you is the need to change and how bothered would you be if you didn't change anything. Talking things over with friends and family sometimes helps, but by no means should anyone else be the validator of your own personal feelings.
As physicians, we all try to keep our patients safe, even from themselves sometimes. It sounds paternalistic, but in reality we all took the oath to "Do no harm."
I would remain conservative at this point
I would be hard pressed to recommend surgery on the picture that you have shown. While you do see a bit more puffiness and a tired look in the eyes, you may not be ready for surgery. One thing that you could consider is the use of Botox. Botox can sometimes give temporary brow elevation. This may give you an indication as to whether brow elevation is what you need or not. If it turns out that you don't like the change it will go away in a few months.
Of course, these issues should always be discussed with your surgeon. If the doctors avoids the questions or does not give adequate answers seek a second opinion. Good luck with your situation.
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Seek out the options as well as the risks and benefits prior to making a decision
I would urge some caution in proceeding and recommend that you be aware of all the potential consequences. For example, although it is difficult to tell from this picture, a brow lift could potentially elevate your hairline and give you a high forehead appearance. There are options to minimize this side effect such as a pretrichal forehead lift (as opposed to an endoscopic forehead lift) bu the tradeoff is more scarring.
Another alternative is a transblepahroplasty browpexy (or brow lift) type procedure which holds the eyebrow in place and can be performed through the eyelid incision. Surgeons have differing opinions on the true benefits of this procedure.
As you can see there are many options and no surgeon can tell you the correct procedure for you. The surgeon may educate you as to the options available as well as the potential risks and benefits. After becoming more aware of the options, it will be up to you to choose the best choice with the surgeon guidance.
I would not recommend either procedure
If you walked into my practice I would not recommend either procedure to you. I might instead attempt to provide slight elevation of your eyebrows using carefully placed BOTOX in an attempt to do a "Pharmacologic Browlift". Otherwise sit back and enjoy your youth!
Less is Sometimes More
I agree with the comments of the other doctors. Both procedures together are probably unnecessary. If anything, a conservative upper lid skin excision would help to re-establish the look you want to be seeing in the mirror.
Endoscopic forehead lift alone
You probably do not need both a forehead lift and an eyelid surgery. It is likely that the forehead lift alone will be all that you need. Be certain that the surgeon you choose is comfortable with the endoscopic forehead lift. Don't get talked into an open forehead lift.
Regarding BDD, ask yourself how many hours a day do you think about this issue. If the answer is that you think about it constantly, you may have BDD which is a type of obsessive thought disorder. You still have a brow issue but it may be that addressing the BDD with serotonin reuptake inhibitors will improve the obsessional quality of these intrusive thoughts and help you think more clearly about what you might need aesthetically.
I would not do surgery yet, but consider Botox for now
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!
Find a good surgeon and build a solid relationship with this surgeon.
Based on your picture alone, I would be careful recommending any surgery. You are certainly very young, and should not take this lightly. It is possible that conservative brow lift or possibly upper blepharoplasty will help you feel better about your eye appearance. I would find a surgeon that you can develop a good relationship with, since this is likely to be one of the many maintenance procedures you will have over the years. Did you like your nose surgeon? If you did, talk to him or her. Do you have someone doing your Botox and Restylane injections? If you are comfortable with this person, talk to them about your concerns. I have similar patients, and yes, they have many procedures over the years, and yes, the question of BDD always comes up. I would make sure you find a doctor that you feel very comfortable with, discussing your issues, and who will listen and keep your interests in mind as opposed to someone who will do things just to do them. It will be really important for you to develop a plan with your doctor, and not do things based on internet recommendations.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.