Can Blepharoplasty Cause Eyebrows to Droop?

Regarding: "Can Blepharoplasty Cause Eyebrows to Droop?
1 yr and 3 months ago I had surgery on my upper eyelids. After surgery I was pleased with the initial result of having bigger eyelids. However, it now seems as time goes on my eyelids get more narrow and now I am almost sure my eyebrows are getting lower. Compared to my pre surgery photos my eyebrow position certainly appears to be lower. It feels very unnatural and I look almost mad at times. Will this continue getting worse? What can I do to fix this?"

Great question! ABSOLUTELY - performing an Upper Lid Lift (Blepharoplasty) when a Brow Lift should have been performed instead ALWAYS leads to brow sagging and reappearance of the "excess" upper lid skin.

As we age, our brows sag AND we accumulate some excess skin of the upper lid. To increase visibility, we compensate by using the forehead muscles to constantly lift the brows. While this "reduces" the amount of excess skin in the upper lids, it creates transverse creases in the forehead skin.

The solution is to elevate the brows in their natural, youthful (higher position) which will reduce the amount of work the brow lifting muscles (Frontalis) have to do and THEN to remove any upper lid skin excess, if needed. However, many patients and surgeons routinely try to avoid the Brow Lift operation and remove the excess upper lid skin ONLY. The result is that once that skin is removed, the Brow muscles relax and allow brow sagging with more skin appearing in the upper lids making it seem no surgery was done.

You MUST have the right operation for the right condition.

Hope this helps.

Dr. Peter Aldea

Most patients who have excess upper eyelid skin compensate by raising their brows.  This is also a result of low brows and serves to improve the appearance of the eyes and brows - most women do this unconsciously throughout the day as it looks more attractive.   Once the upper eyelid skin is gone (after surgery) there is no "need" to chronically raise the brow since the excess upper eyelid skin is gone.  Now, however, the brows demonstrate their true position which is lower than what you were used to.  It is important to understand this phenomenon, predict the changes and realize that in these patients often a brow lift is needed to correct both of the aging processes that are happening simultaneously.

Best of luck

Vincent Marin, MD, FACS

La Jolla Plastic Surgeon

Removing loose skin from the upper eyelid is a common part of upper blepharoplasty. In the absence of a photo or an assessment of your eyes this question is relatively difficult to answer as the answer is dependent on your individual eyes and position of your eyebrows.

For most people having upper blepharoplasty your eyebrows will remain in a similar position after eyelid surgery i.e. they don't droop. 

However for some patients with lower eyebrows or patients that naturally use their eyebrows to lift their loose upper eyelid skin, after blepharoplasty the eyebrows can drop by a small amount. For some patients with particularly low brows, a brow lift may give the best result when combined with upper blepharoplasty. Care is required with brow lift surgery, as over lifting of the brow can create an unnatural appearance and generally a conservative lift is preferred to maintain a natural result.

Careful evaluation of your eyelids before having upper blepharoplasty will enable your individual eyelid characteristics, symptoms and signs to be evaluated and the surgery planned specifically for your needs. It would be worthwhile to see a surgeon who specialises in blepharoplasty and is completing this surgery frequently to evaluate your eyes and specific needs. 

This is quite common and is due to the body's natural compensation for upper lid drooping, it tries to pull the brow up to help the eyelids feel less heavy. After successful upper lid surgery, the brows lose the compensatory signal and will often relax to the point of looking droopy. Hopefully your surgeon recognized this as a possibility prior to surgery and warned you about it. You may need a browlift or a forehead lift now to correct the problem.

The most likely reason your brow is lower after surgery is for the following reason:  Prior to surgery, you were lifting your forehead/brow in order to see better as this compesated and lifted the extra skin away from your upper eyelids.  After blepharoplasty, which removes skin from the eyelid, that drive/compensation is gone, and there the brow descends.  Another reason has to do with time/age.  Overtime, the brow/forehead descend naturally.

You might need a brow/forehead lift. 

Dr Taban