44, looking to eliminate hooded lids - Endoscopic brow lift or upper blepharoplasty? (Photos)

Question

I’m 44 years old and have heard mixed things regarding a brow lift vs upper blepharoplasty. I’m wondering which one will be more beneficial for me? Overall I’m looking to have my eyes look more open, a more defined crease and the hoods gone.

C. Blake Perry, MD · Answer

Blepharoplasty and brow lifting are often done in combination. Judging by your pictures, you would benefit from both an endoscopic browlift and upper lid blepharoplasty. Only doing an eyelid surgery would not address the brow asymmetry and would limit the results.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. An endoscopic brow lift would likely only move your brows a millimeter or two. A subcutaneous temporal brow lift would not be a good option for you as you have a very high forehead. I believe the simplest way forward for you would be to have a skin only upper blepharoplasty, which will help define your upper lid crease and can remove some of the skin responsible for the hooding. This can be done under local anesthesia and has a quick recovery time. Best wishes.

Andrew Miller, MD · Answer

Based on your photos, you appear to be a good candidate for browlift because your eyebrows seem to be below the level of the brow bone. A good endoscopic browlift can lift them a bit and really refresh the area. Then if there is still a little excess skin on the upper lids, and upper blepharoplasty can be done at the same time. Be sure to see a facial specialist for consultation.

Damien Grinsell MBBS, FRACS (Plast) · Answer

Hi

Unfortunately your photos are taken looking up so it is hard to know if the main problem is dropped brows or excess skin in the upper lids.  What I can tell you is that from my perspective the upper lid tuck is the best cosmetic operation we do - it makes you look younger, opens the eyes, makes you look less tired and the scar is almost invisible.  The downtime is about a week, it can be done under local anaesthetic, it is relatively inexpensive and in the right hands the complication rate is very low.  So even if you do have droopy brows most people opt for the upper blepharoplasty.  A browlift is better if you want the brow shape to be change or want the brows to sit higher - you can simulate this yourself by lifting the brow and looking in the mirror and you can see what effect it will have.
Cheers
Damien

Gary M. Horndeski, MD · Answer

You have a large distance between your eyebrows and hairline. I recommend an open browlift where the incision is placed at the hairline to lower the hairline and raise the eyebrows. You will also need an upper blepharoplasty. This can be done at the same time or later.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Guray Yesiladali, MD, FEBOPRAS · Answer

It is not possible to answer accurately from this photo angle, as the image is taken from above. A straight, front-facing photo would allow a more reliable assessment.
From what can be seen, upper blepharoplasty combined with an endoscopic brow lift may be beneficial.
However, the final decision depends on the true brow position, eyelid skin excess and crease anatomy, which should be evaluated from proper photos or an in-person examination.
I wish you a clear treatment plan and a result that makes your eyes look more open, balanced and refreshed.
&mdash; Güray Yeşiladalı, MD

Pedro Literas, MD · Answer

At 44, “hooded eyelids” can come from two different anatomical issues &mdash; and choosing the right procedure depends on identifying which one you actually have.1. Upper eyelid excess (true eyelid skin redundancy)If the heaviness comes mainly from extra skin in the upper eyelid, an upper blepharoplasty is usually the best solution.It removes the excess skin and can define the crease, making the eyes look cleaner and more open.2. Brow descent (especially lateral brow drop)If the outer brow has descended, it pushes tissue down over the eyelid, creating a “hooded” appearance.In these cases, a brow lift (often temporal or endoscopic) is more appropriate because it addresses the root cause.What I often see in patients like you:Most patients are actually a combination of both, with:mild to moderate brow descent (especially lateral)and some degree of eyelid skin excessIn those cases, doing only a blepharoplasty can sometimes under-correct or even make the brow look heavier.My approach:The key is a detailed facial analysis, not a one-size-fits-all answer.In many patients, the most natural and balanced result comes from:conservative upper blepharoplasty + subtle brow elevation(often a temporal brow lift rather than an aggressive full lift)This avoids an overdone look and keeps the result elegant and natural.

Michael Chung, MD · Answer

At 44, what you’re noticing, including heaviness, hooding, and loss of a defined crease, is very common, and the key isn’t choosing between a brow lift and an upper blepharoplasty, but understanding what’s actually causing the heaviness. When I evaluate this, I think in terms of the three pillars of facial aging: skin changes, tissue descent, and volume loss. In your case, this is primarily a combination of tissue descent and excess skin. Over time, the entire scalp gradually descends, and because the brows are attached to the scalp, they descend as well. As the brows settle lower, they push down on the upper eyelid skin, contributing to a more closed, heavy appearance and lateral hooding. At the same time, the eyelid skin itself loses elasticity and begins to bunch and fold, which softens or hides that defined crease. An upper blepharoplasty removes the excess eyelid skin and helps restore a cleaner, more defined crease. A brow lift repositions the entire scalp and elevates the brows, which can improve the heaviness over the upper eyelid, but it usually does not fully correct the excess eyelid skin on its own. Most patients in this situation have both factors contributing, so addressing only one often leaves part of the problem untreated. Based on your photos and concerns, there is a good chance you would benefit from a combination of a brow lift, often performed endoscopically, along with an upper blepharoplasty to achieve a more open, defined, and natural result, although the final recommendation always depends on a detailed in-person evaluation.

44, looking to eliminate hooded lids - Endoscopic brow lift or upper blepharoplasty? (Photos)

Answers (8)

More Eyelid Surgery Questions

Lower eyelid pulled up tightly after lower bleph. Constant twitching, crepey under eye 1 year post. Can this be fixed? (Photos)

4 years post blepharoplasty and my skin is very lax and crepey, can this be fixed? (Photo)

Mid 20's - Best long-term solution for under-eye hollows? (Photos)

How can I improve the look of my eyes? (Photo)

Uneven eyelids - can they be made more symmetric? (Photo)

How can I fix an eye area that looks harsh and has a lot of upper eyelid exposure? (Photos)

WE SEND PRETTY
EMAILS