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

The eyes are the primary facial feature that communicates tiredness or exhaustion (and, likewise, energy and vitality). Your cheeks and your neck don't really reflect whether or not you've had a good night's rest. But miss a night of sleep and your eyes will make it obvious to everyone.

Aesthetic plastic surgery of the eyelids can produce a dramatic  rejuvenating effect, literally taking years off of a person's appearance. Interestingly, many patients find that following eyelid surgery friends will say 'You look great!', but they usually cannot pinpoint exactly why.

If there is a  facial rejuvenation  surgery that is over-recommended and often overdone these days, it is without question the browlift. Look no further than the celebrity photo magazines for pictures of stars who look like they have just sat down on a plate of tacks. The goal of aesthetic plastic surgery should be to make a person look better and more youthful, not merely different, and certainly not as though one is perpetually surprised. My goal is to provide my patients with results which appear natural, and an unnatural-appearing brow is a dead giveaway that a person has had facial plastic surgery.

I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead - if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious

A youthful, feminine brow rests above the level of the orbital rim, which is the upper margin of the bony socket in which the eye resides. An aesthetically pleasing brow is somewhat arched laterally, and the lateral end or "tail" of the brow is higher than the medial end. It is quite common for the female brow to assume an essentially flat or horizontal orientation as a person ages.

If the skin and soft tissues lose enough elasticity with age and sun exposure, the lateral brow may even descend to a level below the orbital rim, producing a tired or even 'surly' appearance. The medial brow is relatively fixed in position and in most cases does not descend much, if any. In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.

Excessive or 'redundant' upper eyelid skin is a very typical aging change that leads people to seek eyelid surgery. In many patients, this surgery can be performed under light sedation with local anesthesia as an outpatient office procedure. In a few cases, protruding fat behind the eyelids is also removed. As with most facial aging changes, no two people present with exactly the same eyelid concerns. Surgical treatment is therefore individualized to the needs of each individual patient.

My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.

The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.
A consultation with a board certified plastic surgeon with excpetional training and significant experience in performing conservative eyelid surgery and lateral browlifts can help you determine the appropriate surgery for you. 

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.

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.

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. 

Many patients need both a browlift and a blepharoplasty. This completely depends on patient anatomy. Keep in mind that most patients tend to lift their brows in response to heaviness of the upper lids, so when the heaviness of the lids is taken away by upper eyelid surgery, the brows do tend to relax and come down, which can negate some of the effects of the upper blepharoplasty. While this does happen in many patients, patients with adequate brow position can often get away without a brow lift as long as they are aware that the brow might relax a bit after upper eyelid surgery alone. 
Also, in some cases, patients may not need an upper blepharoplasty at all, and can see dramatic improvements in the upper eyelid area just by lifting the brows. This depends on the amount of excess upper eyelid skin and fatty tissue that is present within the eyelid.
Be sure to see a surgeon who specializes in facial aesthetic procedures so that they can perform an exam and offer treatment recommendations.
All the best,

I am always surprised if my patients tell me that they saw different surgeons and were always advised to do a blepharoplasty AND a browlift for their saggy eyelids. Many of these patients didn't notice any significant brow descent over the years and it is true that the brow descent over a life time is very very little and usually doesn't cause saggy eyelids. It is indeed the upper eyelid which goes through drastic changes during a lifetime. Skin and connective tissue looses its elasticity, the skin of the eyelid starts sagging, the orbital septum looses its strength and the orbital fat protrudes outside the orbital socket under the eyelids creating the puffy and heavy look of an ageing upper eyelid. 
I created my signature TBT-eyelift procedures which addresses exactly these problems and reverses what time did to our eyes (This is what TBT stands for Turn Back what Time did). During this less invasive procedure under local anaesthesia I can create the eyelid a patient had in her/his youth without lifting their brows. A browlift should just be used if a patient wants to change her/his look and desires a more arched shape of the brow but not to correct saggy upper eyelids. A patient should know that a browlift can totally change the look of a patient and if over-done gives an operated, artificial and not desired look. You should be sceptical if a surgeon talks you into a browlift and bleparoplasty to improve your saggy eyelids. To improve saggy eyelids by a browlift alone is very difficult and the brows must be over-lifted which will result in an artificial look. Be careful!

The only way to answer this is with an evaluation.  Both procedures when done by an experienced surgeon are safe and effective,  There tends to be a fear of browlift surgery which is mostly unfounded.  In face a straightforward brow lift often yields less bruising and swelling than traditional eyelid blepharoplasty.  Have an evaluation by a specialist and ask good questions

This is a really good question, but the answer depends a lot on the patient.  Often times patients will come in to see a facial plastic surgeon complaining of heavy eyes and the cause may be from excess upper eyelid skin and fat (which a blepharoplasty can treat) or from a descended brow (which a brow lift can treat) or a combination of both.  Sometimes patients don't notice that its their brow hanging low over their eyes that causes heavy looking eyes.  Without examining a patient in person, or at least seeing photos, it is difficult to differentiate the cause.  One trick you can use at home is if you stand in front of the mirror, close your eyes and try to relax, and then open your eyes.  If you notice when you go to open your eyes you are lifting your eyebrows every time, then it is likely a brow lift may be in your future.  If this is the case when you do consult with a facial plastic surgeon or plastic surgeon, be sure to review their before and after photos and find out about their preferred surgical technique.  A brow lift can be performed in numerous ways but key is subtle change.  The brow needs to be released from its attachment to the bone and only lifted a few millimeters to achieve a noticeable improvement in aging or tiredness.  If it is lifted too much, it can leave you with a permanent surprised look which you definitely don't want.