I am debating between a brow lift or upper eyelid surgery. Any suggestions? (photos)

I have dry eyes and the surgeon I visited said that I should not do upper eyelid surgery. Would the brow lift be less taxing on my eyes?

Doctor Answers 13

Dry eyes and the surgeon I visited said that I should not do upper eyelid surgery. Would the brow lift be less taxing on my eyes

Hi, I have performed many Brow Lifts and eyelid surgeries (Blepharoplasties) over the past 30 years.  From the photos, your brows do appear low and there is excess skin of the upper eyelids. Aesthetically, a Brow Lift as well as an upper eyelid surgery would be required together to create the wide open feminine upper lid crease. The problem as you mentioned is your dry eye. Any procedure that reduces the amount of upper lid fullness, whether it's a Brow Lift or upper eyelid surgery will increase exposure to the eye and worsen your dry eye. For that reason, I would require a release from your eye doctor before agreeing to perform either procedure. The dry eye will certainly worsen in  the immediate post op period and would require additional treatment measures by your eye doctor.
Hope this helps.


Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

An oculoplastic surgeon is an ophthalmologist and an eyelid specialist, so they can treat dry eyes and perform eyelid surgery

Thank you for your question. You submitted a single photo, and state you visited a surgeon about upper eyelid surgery,  but the surgeon didn’t recommend it because of your dry eyes. You ask if brow lift surgery be less taxing on your eyes.
I can certainly give you some guidance to this question. A little background - I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years and cosmetic eyelid surgery, brow lifting, face lifting, other procedures in this area, and procedures and solutions for facial aging are the core of my practice. This also includes non-surgical solutions like injectables, advanced methods of using blunt cannulas, laser devices, and thermal energy devices.
In your situation, having dry eyes is an important issue. However, will a brow lift make any impact on you, not so much in a dry eye perspective but from an aesthetic perspective. What you are clearly concerned about is some extra skin over your eyes, which is why you probably considered eyelid surgery. The reason why many surgeons are very concerned about dry eyes is because they don’t have an ophthalmology background. Eyelid surgery is typically the 3rd most popular cosmetic surgery, and if the surgeon doesn’t have an ophthalmology background, there are some issues with the management of dry eyes they can’t handle. Very often the surgeon who performs the procedure isn’t the doctor who manages dry eyes.
Myself, having an ophthalmology background, I am familiar with dry eyes - in oculoplastic surgery, we specialize in the lacrimal system which is the tear gland, and tear duct system. I’ve done blepharoplasty for many patients with severe dry eyes. It’s all about management because as I said years ago, and still remains to be true, is that eyelids that look good and function well.
From my experience, and from the aesthetic perspective, I would say a brow lift would not be a good idea. Looking at the photo, the position of your brows seems high enough. I Imagine how much higher the brow would be to get that skin to be more taut. I think if you were to undergo the brow lifting procedure,  it wouldn’t look very natural and you may have constantly surprised look.
I think there are more than a few options for you, and it would benefit you to meet with a cosmetic oculofacial plastic surgeon because there are important issues with the health of the eyes, so someone with an ophthalmology background will be more comfortable in dealing with them. It may be that blepharoplasty or brow lift may not be optimal for you, so a proper examination by a specialist is best for your situation, with all do respect to the doctor you went to. Meet with a specialist and see if you can get some more clarity about the basis of any suggested procedure. It is so important to have good communication and really understand what the outcome will be, and what the impact would be on the health of your eyes. You really want to make this a smooth process as possible. I hope that was helpful, I wish you the best of luck and thank you for your question.
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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 62 reviews

If Reluctant About Surgery, Consider A Nonsurgical Browlift

Unfortunately, a closeup photo would have been more helpful. Nonetheless, it is worth mentioning that nonsurgical browlifts, using volumizing fillers and muscle relaxants have become increasingly popular over the last decade and, in appropriately selected candidates, and performed by experienced aesthetic physicians, can yield immediate and gratifying results, often a "Wow!" response, and require no scalpel cutting, stitches or significant downtime. 
So, especially if you are concerned about your dry eyes, and owing to the fact that you have already been advised not to undergo the surgery, this may be a very viable, quick (usually takes about ten minutes to perform) and relatively inexpensive approach to explore. This has been a first line approach with many of patients for well over a decade. In my Upper East Side Manhattan office, I typically use Juvederm Ultra Plus XC for brows. (In my Israel satellite facility, where a far greater number of regulatory agency approved volumizers are available, I typically opt for Princess Volume). Where appropriate, microdroplets of muscle relaxants, such as Botox, Dysport or Xeomin, appropriately placed may further help to lift the brow. 
I am not a fan of supposed skin tightening devices, such as fraxel lasers, radiofrequency, and ultrasound machines that are frequently advertised for eyelid and brow tightening. In my experience, the results of these relatively expensive approaches tend to inconsistent, subtle, and variable and appear to be supported far more by device manufacturer marketing hype than hard science.For more information on the above, check out the archives of RealSelf.com.
Make sure you consult with a board certified aesthetic physician with experience and expertise in performing advanced nonsurgical facial rejuvenation techniques. And be sure to ask to see his/her before and after photos. Best of luck to you.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 24 reviews

Dry eyes

Hi and thanks for posting your question!
Dry eyes are a relative contraindication for eyelid surgery. Oftentimes, your opthalmologist can quantify how significant your dry eyes are with a tear secretion test. 
A brow lift procedure affects the upper eyelids without directly excising skin from the eyelids themselves-so if you have severe dry eyes, it may be a good option for achieving good results without doing upper eyelid surgery.
Best wishes in achieving your goals!

Eyebrow lift versus eyelid surgery

  The one single photograph demonstrates significant asymmetries of the eyebrows, forehead and eyelids for which a brow lift can improve  the eyebrow position. and upper blepharoplasty procedure can address asymmetry of the upper lid skin and fat is also present. An in person consultation and examination is important to sort out the details. For many examples of both procedures, please see  the  link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

ENDOSCOPIC BROWLIFT WITH MID-FACE SUSPENSION

Dear Dorothyeast, In patients your age who show some signs of aging in the upper third of the face I typically perform and endoscopic brow lift with mid-face suspension. This helps elevate the brows and open up the eyes with no tell tale signs of surgery. With some patients like yourself I would most likely do this is conjunction with fat transfer as you can see in the video example above. The small incisions are placed in the hairline and using an endoscope the facial tissues are undermined down to the malar region and lifted away from their attachments. The entire facial unit of skin, muscle and soft tissue is then lifted upward and laterally providing a very youthful and natural appearance. This is a very rewarding procedure that all of my female staff members have had performed due to it's high level of satisfaction with minimal downtime and discomfort. There are many examples in the link below and video above to show you this does not markedly alter the hairline as no skin or scalp is removed. This procedure does not have the appreciable instance of dry eyes when not combined with blepharoplasty. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 199 reviews

Your eyes

From the p hoto it doesnt look like you need any surgery on your upper lids or brows. I would suggest an inperson consultation if you are dissatisfied with your eyes as the photo isn't the best. 

William B. Rosenblatt, MD
New York Plastic Surgeon
4.1 out of 5 stars 11 reviews

Brow asymmetry

Your photograph shows brow asymmetry. Your right brow may be higher to compensate for right upper eyelid ptosis. A blepharoplasty alone would not correct this. I would recommend an evaluation by an oculoplastic surgeon ( fellowship-trained eyelid specialist that is board certified in ophthalmology). An oculoplastic surgeon will be able to evaluate your brow position, determine the amount of excess skin that is safe to remove, measure levator excursion ( strength of the muscle the opens the eyelid ) and evaluate your ocular surface for dryness. Hope this is helpful. Vikram D. Durairaj, MD FACSAustin, Tx

Vikram Durairaj, MD
Austin Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Bleph

An upper lid bleph would give you a better result than the brow lift.  Your dry eyes may be temporarily worse after an upper lid bleph but this is usually a transient phenomenon and you should get back to baseline.  Because of your dry eyes you should have a more conservative procedure, but should still be able to have a nice result without long term sequelae.  Best wishes, Dr. T

Eyelid surgery

Hello and thank you for your question. Based on your photograph, your brow appears to be in good position.  I do think you could benefit from a blepharoplasty.  With good technique, you can avoid any visible scars and the dry eyes is usually only temporary.  The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 80 reviews

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