Browlift vs. Blepharoplasty - Which is Best for Sagging Eyelids?

This is a key decision and one that you should consider carefully before proceeding ahead. The fact is that most people with heavy eyelids have a combination of droopy brows and excess eyelid skin. The important thing is to decide whether it is a brow lift or an upper eye lift that gives you the best cosmetic outcome. In some individuals, both procedures may be necessary to get the best possible outcome.



First, let's take a look at the ideal brow position in a woman. The inside corner of the brow begins at the root of the nose, and gently climbs to higher level, reaching its peak typically somewhere half way between the pupil of the eye and the outside corner of the eye, and then dropping down at the temple. While in a woman the brow is ideally above the level of the bone and curves upward on the side, in a man, the brow is typically at the level of the bone and tends to be more horizontal.

Now that we have an idea of the ideal brow position, a rather simple test can be performed to see whether you are a good candidate for a brow lift:


Stand in front of a mirror and look straight ahead.

Make sure that you are not intentionally lifting up your brow.

Place the index and middle fingers of both hands, half way between the brow and the hairline, one aligned with the center of the brow and the other at the outer corner of the brow.

Gently lift and glide the forehead skin up toward your scalp. Go back and forth a few times, seeing the effect of the simulated brow lift on the shape of your eyes.

Try turning your head away from the brow, toward your nose, and again glide the forehead skin up toward your scalp, seeing the effect of the lift on the side of your brow.

If you like the look of your eyes with this maneuver and if the crease of your eye becomes more visible and the eye appears more alert and youthful, then you may be a good candidate for a brow lift.


If your brow is resting in a good position but there seems to be excess fullness and folded skin obscuring the crease of your eye, then you may be a better candidate for an upper eye lift. Results of an upper eye lift are more difficult to simulate than a brow lift. An eyelift can typically improve the excess droopy skin that covers the cease of the upper eyelids and in some people can even rest on the upper eyelashes. Eye lifts do not elevate the brow position, and, in fact, can sometimes slightly lower brow position. Lower blepharoplasty or lower eye lift can improve bagginess of the lower eyelids and the excessive wrinkling that some of us get on the skin of the lower eyelids.

You need to have an examination.  However majority of time it is eyelid surgery.  Brow lift if not as popular as it used to be 20 years ago.

If the lateral brows are sagging and heavy and are below the orbital (bony) ridge and if there is not a lot of excess upper lid skin, then a brow lift. (I do it with small incisions in the scalp with an endoscope, no skin excised) alone will stabilize the brows in a good position. 
However, if the brows are down and if there is excess skin, the combination of the endoscopic brow lift/stabilization and upper lid skin excision/blepharoplasty will give you the ideal result.
If the brow is too low, then an aggressive blepharoplasty alone will not give you the ideal result. It may actually make the brow look heavier. 

Thank you for your question.  It really depends on the shape of your eye and your brow.  Most of the time, a sagging brow causes excess skin droop on the eyelid.  At times, simply just removing upper eyelid skin worsens the issue.  I would recommend a consultation with a board-certified plastic surgeon to discuss your concerns.  Best of luck, Dr. Pacella

A brow lift improves just the brow by raising the eyebrows to a more youthful position.  Blepharoplasty would remove any sagging eyelid skin that remains.  A browlift is needed if the heaviness over the eyelids is primarily lateral, and if the whole eyebrow has descended in general.  A Blepharoplasty primarily deals with excess skin that blunts the eyelid crease.  An incision is made and the excess skin is removed, leaving you with a better defined crease to put makeup on.  If you are contemplating having your eyelids done, but don't know which procedure would work best for you, I would schedule a consultation with a board certified plastic surgeon.  

This is a fantastic question! This is a topic discussed at length at every Facial Plastic Surgery conference I have ever attended. It is critically important that your surgeon consider the position of both the brow and the eyelids when evaluating for possible blepharoplasty. Failure to recognize if the brows are contributing to the fullness/droopiness of the eyelids can lead to subpar surgical results. Patients will sometimes subconsciously lift the brows when they have heavy eyelids and this can actually make the fullness worse if not addressed during surgery. On the other hand, sometimes just lifting the brow can lower the position of the eyelids. Each patient has slightly different anatomy, but the brow and the eyelid should always be evaluated both together and in isolation when considering blepharoplasty.
Hope this helps!Kyle Kimura, MDFacial Plastic and Reconstructive Surgery

For significant improvement, hooded eyelids require surgery if there is enough skin. For nonsurgical treatments: Radiofrequency (Thermage or Venus Legacy/Viva), injectable fillers, and a Botox brow lift can help contour the eyebrows and lift the eyelid skin. I recommend getting a formal evaluation with an experienced cosmetic dermatologist. Best, Dr. Emer.

First, I will give you the general definition of both, then I will address the nuance which makes a simple a bit more “grey” than “black and white.” A browlift is specifically used to adjust the position of the brows, usually due to loose skin in the forehead causing the brows to fall over the orbital bone. A blepharoplasty removes the excess skin of the upper (and lower) eyelids. In order to answer your question accurately, the patient would need to be examined to determine the correct surgery, because sometimes, patients might have a sagging forehead which, if lifted, would also improve the sagging of the upper eyelids. The determining factor is to assess if the brows are positioned properly on the orbital bone. The most important key to remember, however, is that a browlift can create a very unnatural expression *if not performed with a sophisticated aesthetic.* The medial area of the brows (where they are closes to your nose) can be, if the brow lift is performed improperly, raised too high, which causes a very strange expression on the patient’s face that resembles a frightened look. The brows in the middle should always sit on the orbital bone, as should the brows on the lateral (side) aspect of the forehead. Some patients may be candidates for both surgeries combined, but they can also be done separately depending on the patient’s anatomy. I recommend consulting in person with a board certified plastic surgeon whose results you admire

The short answer is that both can correct sagging upper lids.
If the brow position is low, it can definitely affect the amount of skin that shows on the upper lids. Typically for men, the brow should sit at the superior orbital rim (brow bone). In women, an aesthetically pleasing brow arches upwards above the orbital rim as you move outwards (lateral brow). When the brow drops below this level, then consider a brow lift.
In terms of excess skin, it all depends on the where we want the final lid crease to be. If the brows are sitting in the correct position, the lid crease should sit anywhere between 5-10 mm above the lashes depending on ethnicity and gender.
Sometimes, I recommend both an upper blepharoplasty and a brow lift at the same time. Other times, just a brow lift or just an upper blepharoplasty. An consultation is usually required to determine what's the best plan of action.

More than any other facial feature, the eyes usually have the most impact on your appearance. Eyelid surgery can bring tired, drooping or puffy eyelids back to life by re-creating youthful contour and long lasting freshness to the eyelids. Upper eyelid surgery addresses the excessive or loose skin which causes a hooded appearance and can obstruct the upper visual field. Brow Lift surgery addresses sagging of the eyebrows, placing them in a more desirable but still natural looking position. When hooding of the upper eyelids is mainly due to sagging of the eyebrow area, then correcting eyebrow height and/or shape provides excellent improvement to the eyes and overall facial appearance. You would need to be assessed by a plastic surgeon to determine which is best for you and in some cases patients may require both an Upper Blepharoplasty and a Brow or Temple Lift.

In most people with sagging eyelid skin some of this is due to brow ptosis (descent of the eyebrow, especially laterally), rather than just excess upper eyelid skin alone. In people with low eyebrow position a browlift will give a better and longer-lasting result compared to upper blepharoplasty alone, and the higher the brow position the less important a browlift will be. Upper blepharoplasty is a simpler procedure that can be performed under local anaesthetic in the office, while a browlift involves a general anaesthetic in hospital (greater expense), so more people have upper blepharoplasty only performed in this situation, rather than the combination. However, if upper blepharoplasty is performed first then a browlift cannot be performed for a number of years.