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.

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.