Bilateral Temporal Brow Lift vs. Upper Lid Blepharoplasty? (photo)

This is commonly a very confusing issue for patients as every recommendation is clouded by our own aesthetic preferences.  I put a lot of emphasis on creating a natural and rejuvenated appearance.  A very easy way to help determine what you want is by looking at photos of yourself when you were younger.  This will tell you what your "youthful eyes" looked like; that is usually what we should try to recreate.  I think your brow position is fine, my feeling is that raising you eyebrows further is going to give you an unnatural and surprised look.  Your photos demonstrate that their is significant excess skin at the outer portion of the upper lid and significant volume loss in the inner portion of the lid.  It is this combination that gives the appearance of your eyes turning down, because our attention is drawn to the shadow under your brow running from high (inner) to low (outer).  In a younger appearing eye this shadow line should run more parallel to the brow above and the eyelid below.  Browlifting will not correct this problem.  My recommended approach for your eyes is an upper blepharoplasty to remove the skin redundancy and a fat transfer (primarily to the inner half of the lid) to address the sunken appearance of the upper lid.  The fat is suctioned out of the belly or thigh and injected into the area.  If this sounds confusing, photos which we have on our website gallery under "upper blepharoplasty" can help demonstrate this.

Well I had the argument 35 years ago and it seems a lot of surgeons still do not get this. 1..gravity works vertically so the brow lift you need isNOT temporal but rather an Irregular Trichophytic  Forehead Lift which we developed for patients like you so your hairline is not raised and you do NOT see a scar. 2. You could hide a "nest of robins" in your upper lid sulcus so a blepharoplasty is NOT needed.