Brow lift, blepharoplasty, or both?

Question

At 34, with children and years of poor sleep, I'm noticing droopy eyelids and a perpetual tired look. Aging is natural, but the last 4 years seem to have hastened the process. Could you recommend a procedure to rejuvenate my appearance based on my photos? My naturally hooded eyes and low-set brow contribute to my concerns, but puffiness and loose skin are becoming more pronounced. If I opt for upper blepharoplasty, will it risk leaving my eyes looking hollow?

Gary M. Horndeski, MD · Answer

Unfortunately, your photographs are limited. However, you appear to have a large brow and your eyebrows are below the level of the orbital rim. You would benefit from a browlift and may or may not need a blepharoplasty. This can be determined by a physical examination.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Lexie Wang, MD · Answer

The best would be to have both a brow reset and upper bleph procedure. A youthful feminine eyebrow usually involves the brow being just above the orbital rim, which I think you can see from these photos as well as feeling on yourself that yours are at the rim if not a little bit lower, esp toward the end of the brow. That tells me that at least some component of your concern is due to brow ptosis. You likely also have some extra skin in the upper lid that the upper bleph could address. The upper bleph alone can also be an option for you but may not be the most definitive treatment. You can have it done without making your eyes look hollow if they take only skin and not manipulate the fat.

Nelson Lee Novick, MD · Answer

Less is more, especially in young people. At least from the photos provided, it would appear that the use of a few microdroplets of Botox coupled with an appropriate medium viscosity HA filler would work very well for created a more feminine, upward and outward flare to the lateral third of the eyebrows, which would secondarily also help to provide some improvement to the very minimal hooding seen in the photos. In experienced hands, the treatment should take no more than about twenty minutes and the results of the filler treatment are typically immediate and those of the Botox usually seen in a few days to a week afterward. 
I would cautious when considering expensive, aggressive, invasive surgeries (that also engender significant post-treatment downtime), especially at this early stage of life. Surgeries, as you can read in many of the Realself posts, also risks the development of  stretch scars and stitch tracks. 
You would be wise to consult an experienced, board certified cosmetic dermatologist filler expert. Best of luck.

Zoran Potparic, MD · Answer

It is very likely that brow lift would be a better choice between the two. You have short, straight brows that may benefit from lifting the outside portion including a temple lift. It may be all what you need for some time. In person consultation with a board certified plastic surgeon familiar with different forms of brow lifts and blepharoplasty is recommended. Good luck.

Toby Mayer, MD · Answer

Irregular Trichophytic Forehead Lift will give you the results you want! A blepharoplasty would look better but the ITFL resets the forehead and the brows. The recovery is one week, based on the more than  5000 of these i have done and DOES NOT leave a noticeable scar.

Darryl J. Blinski, MD · Answer

Based on your posted photos, you seem to have a large forehead therefore, I would only recommend upper lip blepharoplasty. Best to virtual consult with. Fee from $2000.