Opinion on lower Blepharoplasty/ brow tack, why not a Brow Lift? (photos)

First, let me congratulate you on seeing someone I assume is an oculofacial plastic surgeon.  Since you are most concerned with the area around your eyes, this is easily the best type of doctor to see to address your concerns. That said, I personally am not a fan of the brow tack procedure for many reasons.  I prefer brow lifting,. as your post suggests.  I don't wish to make specific suggestions based on the one photo you provided.  I do suggest that you seek out another opinion from an oculofacial plastic surgeon near you with good ratings on RealSelf.  Good luck!

Thank you for your question.  Treating the peri-orbital area can be a challenge.  You have asymmetry and that is actually more common than you think.  It is not clear whether you have botox in the forehead, as the position and the shape of the brows look off a little.  My preference is to not take additional volume from the eyes as a sunken look to the upper eyelids can age someone.  If you look critically at your pictures, you will see a few things.  First, the medial (inside) brow looks descended below the level of the bony rim and that is something that a browlift can address.  Secondly, You want to have a gentle curve of the brows above the rim (.75-1cm) with the high point being at the level of where the colored part of your eye touches the white (lateral limbus). Last is that you do in fact have a lower eyebrow on the affected side and this needs to be addressed.  The technique is surgeon specific, but if those core issues are not addressed, it may not look natural.

One more thing, if you truly meant for me to look at your lower eyelids, then yes, you have hollowing.  You are probably thin and have noticed more hollowing around the eyes.  Look into Fat Grafting to that area.  The results are phenomenal.

Please seek the advice of a Facial Specialist who is double board certified in Facial Plastic and Reconstructive surgery.

Your issue has nothing to do with your eyebrows.  You have upper eyelid ptosis with a dehiscence of the upper eyelid levator aponeurosis tendon.  You are lifting your eyebrow to compensate.  Doing a browpexy procedure will not help you.  It will make both eyes look hollow.  Do to the levator dehiscence, you have an inversion of the upper eyelid so you are missing a normal upper eyelid fold on the right and the fold on the left you fold is hollow but there is the appearance of a fold because the brow on the left side is not as compensated as the right (there is more elevation of the right eyebrow).  That is due to the fact that you have more ptosis on the right side.  Please don't go to eyelid surgeon who do not understand eyelids.  You need an anterior levator resection ptosis repair.  This also creates the opportunity to make a more normal upper eyelid fold and allow the eyebrow to relax to a more natural position.  I also do not think you will benefit from lower eyelid surgery.