Browlift vs Blepharoplasty - which is best for sagging eyelids?

I agree with many of the comments made by the other surgeons.  Deciding whether to have a browlift, blepharoplasty, or a combination of both is a very individual decision that involves your particular anatomy, your aesthetic sense, and the aesthetic sense of your surgeon.

I believe that a browlift can be an excellent procedure when done for the right indications.  However, I feel that that are a good number of browlifts that are either overdone, or should not be performed at all.

I'd like to comment on a point that has not be raised in detail.  A critical part of the the consultation involves you and your surgeon familiarizing yourselves with how your brow has moved over the years.  This is done by reviewing pictures from decades ago.  In some people the brow has slowly descended over time.  These patients are more likely to benefit from a browlift.  Other patients always had a lower brow.  As some other surgeons have commented, fashion magazines are full of beautiful people with relatively low brows.  If your brow was always low, a browlift is more likely to give you an outcome that appears unnatural to you. 

Reviewing old pictures is important for many facial plastic surgeon procedures, but especially so for the browlift.

For more info:  http://www.idealplasticsurgery.com/plasticsurgery_browlift.htm

Hope that helps.

It depends on where your eyebrow sits above your eye. Your eyebrow should sit above your eyelid margin about the size of the width of your iris. So depending on where your eyebrow sits, you will be a better candidate for an eyebrow lift or just an eyelift.

If your eyebrow sits below the distance of the width of your iris, you could benefit from an eyebrow lift. If it sits above this distance, an eyebrow lift could make you look surprised. That distance determines whether you look suprised or maybe more stern-looking or tired-looking.

If you elevate the eyebrow much more than the width of the iris you could have that surprised look. A little more than that distance is okay, but once you start approaching 1 1/2 times the distance of the iris, the suprised look takes on more prominence. After elevating your eyebrows, you are then more able to determine how much skin to take.

Hope that helps.

Browlift and blepharoplasty (upper) are not mutually exclusive procedures--they can be done in conjunction. In some cases, neither procedure will address your particular problem. It all depends on proper evaluation of the eyelid/brow complex, as well as a detailed discussion of your concerns and your surgeon's aesthetic sense. 

In my experience, I think browlifts tend to be overutilized, and can give a surprised/startled look. On the other hand, upper blepharoplasty when performed too aggressively can make you look skeletonized, "operated", and/or unnatural (eg, kenny rogers!). 

Make sure you seek a surgeon (facial plastic, plastic, oculoplastic) who is not just experienced doing eyelid/brow procedures, but also has aesthetic ideals that matches yours.

Hope this helps!

These two procedures are often complimentary and not always exclusive.

Generally, the eyelid lift handles the excess skin occuring between in the inner and outer corners of the eye (canthi). In lay terms, women often complain that they cannot see their eyeshadow or have the sensation that they eyelid skin rests on their eyelashes.

Skin excess occurring outside the outer corner of the eye (lateral canthus) is often better managed with a brow/forehead lift. We refer to this excess skin as the hooding. In lay terms, this skin is located in the crow's feet area. When people have excess skin here, it is not uncommonly associated with upper eyelid skin.

People unconsciously tend to lift up the extra skin by elevating their brows. This results in many forehead wrinkles. Therefore, forehead lifts are more commonly performed with upper lid lifts rather than vice versa.

The eyes are the primary facial feature that communicates tiredness or exhaustion (and, likewise, energy and vitality). Your cheeks and your neck don't really reflect whether or not you've had a good night's rest. But miss a night of sleep and your eyes will make it obvious to everyone.

Aesthetic plastic surgery of the eyelids can produce a dramatic [weblink:http://www.michaellawmd.com/rejuve.html|rejuvenating] effect, literally taking years off of a person's appearance. Interestingly, many patients find that following eyelid surgery friends will say 'You look great!', but they usually cannot pinpoint exactly why.

If there is a [weblink:http://www.michaellawmd.com/rejuve.html|facial rejuvenation] surgery that is over-recommended and often overdone these days, it is without question the browlift. Look no further than the celebrity photo magazines for pictures of stars who look like they have just sat down on a plate of tacks. The goal of aesthetic plastic surgery should be to make a person look better and more youthful, not merely different, and certainly not as though one is perpetually surprised. My goal is to provide my patients with results which appear natural, and an unnatural-appearing brow is a dead giveaway that a person has had facial plastic surgery.

I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead - if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious

A youthful, feminine brow rests above the level of the orbital rim, which is the upper margin of the bony socket in which the eye resides. An aesthetically pleasing brow is somewhat arched laterally, and the lateral end or "tail" of the brow is higher than the medial end. It is quite common for the female brow to assume an essentially flat or horizontal orientation as a person ages.

If the skin and soft tissues lose enough elasticity with age and sun exposure, the lateral brow may even descend to a level below the orbital rim, producing a tired or even 'surly' appearance. The medial brow is relatively fixed in position and in most cases does not descend much, if any. In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.

Excessive or 'redundant' upper eyelid skin is a very typical aging change that leads people to seek eyelid surgery. In many patients, this surgery can be performed under light sedation with local anesthesia as an outpatient office procedure. In a few cases, protruding fat behind the eyelids is also removed. As with most facial aging changes, no two people present with exactly the same eyelid concerns. Surgical treatment is therefore individualized to the needs of each individual patient.

My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural [weblink:http://www.michaellawmd.com/fatgraft.html|fat grafting] (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.

The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid. 
A consultation with a board certified plastic surgeon with excpetional training and significant experience in performing conservative eyelid surgery and lateral browlifts can help you determine the appropriate surgery for you.