Blepharoplasty Liposuction and Brow Lift for Excess Eyelid Skin?

Question

I am 48 yrs. old and have inherited excess skin on one of my eyelids, but as I age both are showing excess skin hanging over corners of eyes.  The opthalmologist / cosmetic surgeon that I saw recommended Blepharoplasty, Liposuction to the inside corners and a Brow lift.  I am concerned this this is too aggressive and I might have regrets as I age.  What are your thoughts?

Trevor M. Born, MD · Answer

Dear Mon1234
The Eyebrow position is an important feature in facial aesthetics. The height of the eyebrow may change with age but more importantly the volume of the tissues around the eyes decreases in most persons.  With the volume loss, the eyebrow may give less shape and frame to the eyes.
Lifting the eyebrow can give a stylized look- which if you like- is a good procedure to have done.  You may do the procedures separately- eyelids first - eyebrow lift later.
With Warm Regards,
Trevor M Born MD

Frank P. Fechner, MD · Answer

We certainly do not shy away from combining both of these procedures to enhance the upper portion of the face/ eye region. BUT conservatism of the browlift is important. A browlift is certainly the one procedure where the surgeon should not show how high he can lift the brows. Rather, I like to reposition the eyebrows reliably and appropriately for an aesthetically pleasing enhancement. At the time of a browlift, we have the unique opportunity to soften frown creases and forehead lines so that most patients will not require Botox treatments after a browlift.
With an upper eyelid lift, excess eyelid skin is reduced and often prominent fat removed from the inner eyelid corner (but not with liposuction because of the extremely delicate nature and specific anatomy of this anatomical region).

Shahram Salemy, MD, FACS · Answer

Treating both the eyelids and the brow together is a common approach, but I have not heard of liposuction to the eyelids. What your doctor may have been saying is that there is some fat there that would need to be directly removed, not suctioned (big difference between the two). If that is the case, his approach seems reasonable.

Eric M. Joseph, MD · Answer

I read your question, and it's difficult to comment on this combination of procedures without seeing your photos.
In general, you'll look refreshed with removal of excessive upper eyelid skin. When it comes to removing eyelid fat, I tend to be very conservative or remove none at all.
I'm not a big fan of brow-lifting. The endoscopic brow lift procedure can cause elevation of the middle of the eyebrow which can look unusual. You can get natural non-invasive brow rejuvenation with BOTOX at a fraction of the price.
I've attached a link to my blepharoplasty photos for your perusal.
I hope this helps, and best regards.

Kenneth D. Steinsapir, MD · Answer

Dear Mom1234
Less is definitely more.  
However, this gets back to a simple issue. Not all surgeons are created equal. Doing your homework means finding a cosmetic surgeon who makes sense for you. One does not need to have the blue plate special to be improved.  Did you feel your potential surgeon was listening to your concern? Did they spend time with you and address the your questions, or did you get shuffled off the the surgical counselor?
You should know that it is very important to preserve the subbrow fat and not take everything. You should not have your eye skeletonized. One of the doctors responding to your questions is actually advocating an open forehead lift, a very debilitating methods of performing a forehead lift that kills hair and leaves the scalp numb.
Let me strongly encourage you to keep looking for your surgeon.  I am not sure where you live in Ohio.  However, I can comfortably recommend Jill Foster, M.D. of Ophthalmic Surgeons and Consultants of Ohio in Columbus.

Jeffrey E. Schreiber, MD, FACS · Answer

Aggressiveness for eyelid rejuvenation depends on the amount of excess skin and sagginess of the eyebrows. The procedures offered to you may be exactly what you need to achieve your aesthetic goals. If you have any doubts, it may be wise to obtain several other opinions to see what they would recommend. Then, choose your plastic surgeon based on your comfort level with him/her and make sure that both sides agree upon the goals to be met and how to meet them. Good luck!

Toby Mayer, MD · Answer

If you are only concerned with the hanging skin of the upper eyelids, then a good forehead lift will kill 2 birds with 1 stone. The brow will be placed where it used to be and this will "remove" the upper eyelid over hang. If you have bags in your lower eyelids, then you can have these removed.
You might want to see an experienced plastic or facial plastic surgeon to discuss where the incision for the forehead lift should be placed. If the incision is behind the hairline, it is going to raise it. He can give you the pros and cons of each way.

Christopher L. Hess, MD · Answer

Eyelid rejuvenation takes more forms than we have time for now. As we age the brows will fall, excess skin develops because of the aging process and brow descent and bags under the eyes and fullness over will develop as the eyelid septums weaken and the fat pushes forward. With this said any and all of these can develop at any given time. So without a picture it's impossible to say but my suspicion is that an endoscopic brow lift may be enough. Or an upper lid blepharoplasty with internal browpexy may also be appropriate.

William Portuese, MD · Answer

It is not a good idea to have liposuction done around the eyelids since the fat is actually sculpted and manually teased out very precisely. The excess eyelid skin is addressed through a traditional blepharoplasty technique where a small strip of skin is removed from the upperlids. A browlift is only performed for people who have low brows. If the position of the brow is adequate, there is no sense performing a browlift. Surgical correction of the corrugator muscles and frontalis muscles for the forehead wrinkles can also be addressed at the same time as the browlift.

Steven Wallach, MD · Answer

While an upper lid blepharoplasty combined with a brow lift can be beneficial, I have never heard of liposuction of the upper lids or brow. First, there is not that much fat there. Second, fullness is the sign of a youthful upper face, and third, you may injure a vital structure( the eyeball) with the cannulas in that region.

Blepharoplasty Liposuction and Brow Lift for Excess Eyelid Skin?

Answers (14)

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