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.

The aging process involves both the eyelid and the brow, particularly the lateral brow.  Lateral hooding of the upper eyelid is best addressed by raising the brow laterally, which can be done through a limited incision in the temple and is usually best combined with a blepharoplasty.  There are occasional patients who benefit from a browlift without a blepharoplasty, but usually sagging eyelids are a combination of sagging brows and extra eyelid skin.  The procedures have to be tailored to the patient.  An upper blepharoplasty is a simpler procedure with easier recovery, so some patients would prefer to have a blepharoplasty by itself and accept an incomplete correction.  Only occasionally will patients benefit from a browlift by itself.

This is a good question. To be honest I really need to see you. There are a few things that come into play here. #1 the muscle activity of the orbicularis around the eye. This can come into play in to ways. It can pull the brow down and it can lead to big wrinkles and folds of the lids. # 2 Brow position. This can make the lids look heavy. So often there is a combination of both that are needed. I typically do the brow first and then see if that is adequate. Probably about 30% of the time the patient also benefits from a secondary upper lid blepharoplasty. Hope this helps.Best of luck,DrC

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!