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Considering upper eyelid blepharoplasty: Is skin or fat removed? Should I have a brow lift too? (photo)

I'm 51 and have always had hooded eyes. The pooling of tissue is worsening. For years I've been pulling my brows up unconsciously to look & feel more awake/friendly. I do it nearly constantly (and my forehead is becoming heavily lined as a result). Should I have skin or fat removed, or both? And should I have a brow lift at the same time? I'm worried the brows will fall a little, either from the surgery or just because I'll no longer be holding them up constantly.

Doctor Answers (21)

Hooded Eyelids, Drooping Brow. Should Eyelid Surgery or Browlift Also Be Done?

+1
Browlifts seem to be overdone, particularly ones that overly elevate the brows. Since hooding has been a long-standing problem for this patient, it is reasonable to remove the excess skin and see if the problem is solved. I usually remove only skin because removing a lot of upper eyelid fat and too much skin changes the entire look of the eye, making it look hollow or deep set when the patient has always had a hooded appearance as part of their normal look. Preserving volume by not removing fat keeps the eyes from looking prematurely aged.
Although a brow lift is a good procedure for the really droopy brow, it can change the normal brow position to being too high.  If this patient had some descent of the brow after upper eyelid surgery, her options would include Botox browlift, a non-surgical way of tipping the balance of brow position to a higher position by decreasing the tone of the muscles that depress the brow (glabella and upper crows feet) and retaining the lifting tone of the forehead muscle (frontalis). A browlift can be done laterally from the temple only to hold up the tail of the brow, or endoscopically with additional central and paramedian ports to hold up all of the brow. The goal would be to stabilize the brow position at the orbital rim without artificially elevating it.


Mountain View Plastic Surgeon
5.0 out of 5 stars 25 reviews

Upper eyelid lift (blepharoplasty) with or without Forehead lift

+1
Hello 'KVMooMoo', thanks for your question.  Blepharoplasty (eyelid lift) is a very common procedure performed by plastic surgeons that can significantly improve the visual deficits from hooding as well as the overall aesthetics of the eyes, getting rid of the 'tired' appearance.  In this procedure, the eyelid skin and variable amounts of fat are removed to help contour the eyelid region.  Although in the past, it was routine to remove significant amounts of fat, this has largely fallen out of favor due to the hollowing out and aged effect that it can produce.  A small amount of fat removal can achieve a nice result based on each individual person's anatomy.  You make a good point that frequently we see relaxation of the brow due to the loss of the compensatory elevation necessary to clear the upper eyelid hooding, which is removed after blepharoplasty.  A good way to test if you would benefit from a forehead lift in addition to a blepharoplasty is to close your eyes and check the level of your eyebrows relative to your orbital bony rim.  In ladies, the brow should rest at or slight above the orbital rim for the best aesthetic results.  Of course, if you are mainly concerned with the visual deficit from your hooding, you may be able to get a functional blepharoplasty covered under your insurance plan after you get visual field testing documenting your deficit.  However, insurance plans do not care about aesthetics and they will not cover a cosmetic blepharoplasty or a forehead lift.  For the best results, you should go see a board-certified plastic surgeon who will do the appropriate workup and discuss the best options for you.  Good luck!

-Dr.92660

Parviz Goshtasby, MD, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 1 review

Upper lid blepharoplasty and brow lift

+1
There is no substitute for an in person consultation and hands on exam. Your photo is of limited exposure but an upper blepharoplasty ( with skin and fat removal ) and some type of brow lift ( trans bleph. , endoscopic, etc) should give you the best esthetic result. Get several opinions. Wish you the best.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

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BLEPHAROPLASTY

+1
From the pictures, you are a good candidate for an upper blepharoplasty, one that removes the excess skin and a small quantity of fat to give the eyelid more refinement and definition.  Difficult to say for certain if you require a brow lift.  You may decide to stage the procedures.  In other words, have the blepharoplasty first  --> reevaluate for the browlift after to see if you and your surgeon think it is worth pursuing.  Good luck!

Jeffrey B. Wise, MD, FACS
Wayne Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

Upper eyelid blepharoplasty and forehead lines

+1
Dear KVMooMoo
  • Thank you for the photo- The upper eyelid 'hooding' can be treated with blepharoplasty  (the amount of skin, muscle and fat can be discussed after an in person examination at consultation)
  • Your forehead "heavy lines" can be improved with treatment other than a brow lift,  
  • Your concern of the brow position after eyelid surgery is reasonable, but not commonly a problem. 
Best Wishes


Travis T. Tollefson, MD, MPH
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

Upper eyelid surgery for hooded lids

+1
The primary goal of upper eyelid surgery is to remove hooded excess skin on the upper lids. The secondary goal is to remove a small amount of fat that is creating the puffiness look underneath the skin. A combination of skin and fat should be removed to give an excellent cosmetic result.  With the limited one photograph, it does not appear that a brow lift is needed at this time. For many examples of upper blepharoplasty in our practice, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 54 reviews

Considering upper eyelid blepharoplasty: Is skin or fat removed? Should I have a brow lift too?

+1

From the small photo you shared, it appears you would benefit from upper and lower eyelids surgery.  As for the eyebrows, a more complete photo of your face would help.   You can send us a photo for evaluation and I could give you a better idea.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Brow lift vs upper blepharoplasty

+1

From the photo, it looks like your left brow is lower than your right brow. Does that bother you?  You probably need an upper + lower blepharoplasty and a discussion with your surgeon will help you make a dicision so that you will get an excellent result.

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
4.5 out of 5 stars 2 reviews

Considering upper eyelid blepharoplasty: Is skin or fat removed? Should I have a brow lift too?

+1

Easy answer is YES! But over the internet does not allow a definitive surgical plan to be discussed... Best to seek oNLY IN PERSON opinions in CA.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Considering upper eyelid blepharoplasty: Is skin or fat removed? Should I have a brow lift too?

+1
Most likely an upper blepharoplasty could involve removal of skin, muscle and a small amount of fat. If the asymmetry in your brows (the brow on the right side of your photo sits lower than the left) and slight droop concerns you these likely could be improved with a browlift.

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

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.