Trying to Decide Between Madonna Eye Lift or Blepharoplasty? (photo)

Hello. I am a 38 yr old woman that is trying to decide between having upper and lower blepharoplasty or the co2 factal laser. I am also struggling with loss of elasticity in lower face and neck, what can be done for this? Thanks!

Doctor Answers 9

Blepharoplasty vs Laser Resurfacing

In your case surgery is best.

It can difficult to decide between the many surgical and non-surgical rejuvenations options available.  Eyes are the first place to show signs of aging and therefore the reason patients first come to a plastic surgeon’s office. 
The cause of an aged appearance to the eyes can vary.  Textural changes of the skin can be addresses with lasers to tighten the skin and improve the skin surface.  The other cause is contour irregularities from weakening of the tissues and support structures that hold the deeper fat pockets in place. 
In your case you have very nice skin.  While a laser can provide some further improvement in skin texture and tightness, it will not provide the rejuvenation that you are seeking.
I would recommend an upper eyelid blepharoplasty removing a small amount of skin to show more of the upper eyelid.   For the lower eyelids a conservative fat excision and fat repositioning with fat transfer would be best for you.   The fat transfer will place volume into the areas of shadows of the face and eyes creating an overall smoother contour and rejuvenated appearance.


Palo Alto Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Trying to Decide Between Madonna Eye Lift or Blepharoplasty? (photo)

Your best bet to rejuvenate your eyelids is to have surgery.  CO2 laser will probably not do enough in your case.  Your eyebrows are also drooping so you should be seen in consultation to go over all your options.  Your lower face needs to be evaluated in person to decide what the best treatment is.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Madonna Eyelift vs. Blepharoplasty

You look tired ! Brow position is borderline but upper and lower lids (with fat transposition ) will definitely have to be done. Watch out for some malar edema (puffiness) you have, which may not improve with surgery and that may be the result of allergies, sinus problems or fluid retention.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Trying to Decide Between Madonna Eye Lift or Blepharoplasty?

Based upon the posted photos in my opinion only surgery will improve the appearance of the eyes and face. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Browlift or blepharoplasty.

Your facial aging isore than average.  You need a forehead lift and a lower blepharoplasty.  The skin can be done with a mini lift to remove the excess skin. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Blepharoplasty eyelid surgery

Your posted photos show some brow drooping, excess upper eyelid skin hanging down on to the upper eyelid lashes on forward gaze, deep tear troughs and palpebromalar grooves, moderate nasolabial folds, loss of facial fat around the cheek bones and early jowling from descent of the remaining cheek soft tissue. The neck cannot be assessed from your posted photos.`Fractal laser will not affect tissues deep to the skin so it alone cannot improve most of what I have described and it certainly cannot shrink all of the upper eyelid excess skin.

Your best option depends on how aggressively you want to go. Fat grafting around the cheek bones and blepharoplasty of all 4 eyelids is one way to go or you could go the route of facelift and blepharoplasty of the 4 eyelids. You definitely have more advanced facial aging than would be expected so stopping smoking, sunscreen etc. are important in your case.

If a visual field test shows obstruction of the upper visual fields your health insurance may cover the upper eyelid blepharoplasties.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Aging eyes and face

Based on your pictures, you look older than your years. Blepharoplasties and perhaps a fac lift could make you look much better. 

Sheldon S. Kabaker, MD FACS
San Francisco Facial Plastic Surgeon
4.4 out of 5 stars 35 reviews

CO2 laser vs. eyelid surgery.

Not much grey area here.  If you're talking about CO2 laser of the eyelid skin to tighten it you're not going to get the results you're looking for.  Just get the excess skin and possibly conservative fat removal performed for your uppers.  The lowers you could do non-surgical with volume (fat, filler, or plasma) and CO2 laser.  The link has some information about fat and plasma for your lower eyelids and cheeks.  Recovery for upper eyelid surgery is about a week to be mostly functional. Fat transfer and plasma plus laser for the lowers would give you about 7 to 10 days down time.


Best of luck


Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews


Upper blepharoplasty is probably the best procedure for your upper eyelids.

In regards to your lower eyelids, you can benefit from lower blepharoplasty (fat repositioning or remval) and skin tightening with peel or laser.

See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 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.