Do you agree about the suggested procedures for improvement? (photo)

I have been advised I need a Upper Bleph, Transconjunctival Lower Bleph and a Lateral Browlift to get the results that would improve my eye appearance. After looking at my picture would you agree? Thank you for all your suggestions.

Doctor Answers 12

How much surgery is needed????

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Thanks for your question.  It seems to me that an Upper Blepharoplasty would meet your needs nicely.  Botox can help with the "eleven" lines between your brows.  As far as the lower lids are concerned, I think you would benefit more from laser or a chemical peel to tighten that skin laxity.  Best of luck.

Do not agree based on your photo.

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I think you do not need a forehead lift.  You can have a very nice result simply with an upper eyelid surgery.  For the lower eyelid, I do not believe that you need a transconjunctival lower blepharoplasty.  This is a surgery designed for herniated orbital fat.  You do not have this so one can reasonably expect that this surgery will do nothing for you.  I would not recommend a skin pinch either.  Instead, you can have a wonderful lower eyelid result with a phenol 89% chemical peel.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Recommendations for improvement

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I believe you would benefit from a brow lift and laser resurfacing. If your brows are elevated just above the orbital rims, you may not need need the upper lid blepharoplasty (examination is important to determine this). CO2 fractional ablative resurfacing often tightens the lower lid skin enough to eliminate the puffy appearance and tear troughs - if not, laser plus a little filler is a nice alternative to the lower lid surgery. Seek several opinions. You may not need all three surgical procedures for a delightful and less invasive rejuvenation! Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 12 reviews

Improving appearance of your eyes.

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From your photographs, it would appear that you would benefit from a brow lift and upper blepharoplasty. With regards to the lower eyelids, in my opinion, a tradional lower blepharoplasty would be a better option,as this would address the laxity that is present. Of course, a examination would be necessary to make a definitive recommendation.

Upper face and eyelid rejuvenation choices

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Thank you for the question and the photo. First, I think that making a recommendation based on a single photo, rather than a series of clinical photos or (better) an in-person exam, is not a great idea. Second, there are many ways to achieve rejuvenated upper face and eyes -- sometimes the "best option" may be multiple options. With these caveats, I would say the following: 1) a lateral or temporal browlift is a great procedure, and one that I do regularly; this does nothing for the corrugator muscle activity (11's); 2) a conservative upper blepharoplasty without removal of fat should help you to achieve a nicer upper lid crease; 3) it doesn't seem like you have a lot of lower eyelid fat bulging... there is extra skin however, and this can be tightened with laser resurfacing or peels, or a conservative skin pinch procedure. Best of luck moving forward!

Do you agree about suggested procedures for improvement?

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From the one very limited tangential photograph, it appears that the  eyebrows are in a good position. Performing an upper and lower blepharoplasty should be all that's needed. In our practice, we perform lower lid fat removal through a trans-conjunctival approach, with the incision placed on the inside of the  eyelids. When patients have excess and loose skin in the lower lids, a small incision on the lash line is done and a pinch technique of excess skin is removed. This incision is closed with tissue glue. For many examples and more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Brow Lift, Upper and Lower Blepharoplasty or Eyelid Lift

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I agree with upper blepharoplasty for you.  A lateral browlift will not help address the hyperactivity of your frowning or corrugator muscle (between the eyebrows).   Of  course, you could always do Botox to take care of that issue.  Looks like you have more volume loss from your picture so removing fat with a transconjunctival blepharoplasty may not rejuvenate your eyes the way they could be.  Orbital fat repositioning or fat injections helps in those cases.  You also need something to tighten the skin on the lower lids like a lower lid skin pinch, laser or chemical peel (or skin pinch and laser or chemical peel). Hope this helps!

James C. Marotta, MD
Long Island Facial Plastic Surgeon
4.9 out of 5 stars 119 reviews


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All of those procedures sound reasonable, I would consider a lower lid skin pinch as well. You will likely need a canthopexy to support the lower lid.  Best to be evaluated in person.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Rejuvenating the eyelids and upper face

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In the right hands, many techniques can be used to refresh the upper face in a patient like you.  

You should seek opinion from experienced board-certified plastic surgeons IN PERSON so you can have an examination to see if what you would like is possible.  The surgeons may suggest different procedures, based on their own experience of what works for faces like yours.

Best wishes,


Rejuvenation of eyes and brow

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I would agree you were a good candidate for a brow lift, upper blepharoplasty, and lower blepharoplasty. I would further complete your look by replacing the missing volume of your tear troughs and upper cheeks through fat transfer, and using a laser to treat the wrinkles under your eyes. 

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.