As we get older, our skin loses elasticity, and wrinkles, fine lines, and sagging start to set in. One of the places where this is often most noticeable is around the eyes. Whether it’s due to drooping skin on the forehead and eyebrows or excess skin on the upper eyelid, signs of aging in this area can be difficult to address through noninvasive means—which is why many patients turn to surgery. Two popular procedures to correct sagging in this area are the brow lift and blepharoplasty (aka an eye lift, when done on the upper eyelids), but determining which is the best solution for your particular concerns can be challenging. We asked Dr. David Shafer, a board-certified plastic surgeon in New York City, to explain the difference between a brow lift and a blepharoplasty and to weigh in on the best candidates for each.
What is a brow lift?
While there are several different brow lift techniques—depending on the point and method of entry, the severity of aging and sagging, and the patient’s desired outcome—the common goal of all is to address the excess or drooping skin of the forehead and eyebrows. The main focus of a brow lift is, of course, to lift the brows, but the method also tightens the upper eyelid skin, albeit not directly, since no lid skin is removed. “In most cases, skin is removed and then tightened, and the incision is made at the hairline at the top of the forehead, behind the hairline, or directly above the brows, depending on the anatomy of the patient,” explains Dr. Shafer. “Sometimes, the procedure can be performed with [endoscopic] cameras, through small incisions or even through an incision in the upper eyelid.”
What is blepharoplasty?
Unlike a brow lift, an upper blepharoplasty focuses entirely on excess skin of the upper eyelid and is usually performed when this skin touches the lash line or obstructs vision. “In this surgery, an incision is hidden in the natural crease of the eyelid, and the extra skin is removed,” Dr. Shafer says. Since a brow lift will tighten upper eyelid skin as well as lift the brows, the plastic surgeon notes that blepharoplasty should be done when the patient’s only issue is excess eyelid skin.
What is recovery like for each?
Both a brow lift and a blepharoplasty take around an hour to perform and are typically done under general anesthesia, although local anesthesia is possible, in select cases. “Patients can usually return home about 30 to 60 minutes after the procedure, and any sutures are generally removed within a week,” Dr. Shafer explains. “Patients can expect some swelling and possible bruising, which generally resolve within one to two weeks.” Your doctor may prescribe pain medicine for the first few days and, in the case of blepharoplasty, eye drops. To address any residual redness and to promote further healing, some may choose to do a laser treatment on their incisions, one month after the surgery.
Who is the ideal candidate for each surgery?
“For brow lift, the ideal candidate has a heavy brow,” says Dr. Shafer, “while for blepharoplasty, the ideal candidate has heavy eyelids.” This means that the eyebrows or eyelids are noticeably droopy and may sag so much that they interfere with vision. While there is no particular age affiliated with either procedure, many patients who ask about a brow lift or blepharoplasty are around 40 to 50 years old, says Dr. Shafer. Both procedures are commonly performed at the same time as a facelift, at an additional cost.
“If the patient has heavy brows and eyelids, then [either] a brow lift may be sufficient or both procedures may be required,” Dr. Shafer notes. “If a patient has good brow position and no laxity to the forehead but has heavy upper eyelids, then a blepharoplasty would be the better choice.” The goal with both procedures is a natural appearance, and pulling the brow too much during a brow lift can give a surprised look, just as taking away too much skin or fat during blepharoplasty can give a hollow-eyed appearance. That’s why it’s crucial to discuss your goals with a board-certified plastic surgeon so they can perform the procedure that’s right for you.
Related: 8 Things to Know if You’re Considering Eyelid Surgery
