Lower bleph, upper bleph and brow lift? (photo)

I'm 47 years old and looking to refresh my eyes. I consulted for a lower bleph, and received 2 conflicting opinions. The first, an ocular plastic, said my brow bone was fine and that an upper bleph or brow bone in not necessary. A lower bleph with a skin pinch at the corners would do. The second, a facial plastic, wants to do upper, lower bleph a AND a brow lift but no pinch. Is it really time for the upper and brow lift?

Doctor Answers 14

Upper and lower blepharoplasty (+/- browlift)

Based on the pictures provided, I believe you would benefit from a bilateral upper and lower lid blepharoplasty.  Given the findings, I would typically recommend this lower lid blepharoplasty be carried out transconjunctivally.   It seems like you'll need to undergo a bro at some point, but there is no immediate need to carry this out with any urgency at this point.

Boston Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Upper and Lower Blepharoplasty with Lateral Browlift

After reviewing your pics, I believe you would benefit from a modified lateral brow lift to help mildly elevate the outer portions of your brow.  Upper Blepharoplasty, would be recommended to remove excess upper lid skin causing lateral hooding.  As far as the lower lids, I would suggest tranconjunctival blepharoplasty to remove excess fatty tissue in the lower lid area.  I do not see much excess skin in the lower lids from the pics you provided.  If minor skin excess is present, skin pinch or laser resurfacing of the lower lid area are recommended. Good Luck!

Anthony Corrado, DO
Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 35 reviews

Quad Bleph and Brow lift

Thank you for your question. I think you would love the refreshed look you would get with upper and lower blepharoplasty as well as the browlift. However, if you didn't want to do all three you could just do the upper and lower lids now and then do the brow at a later. You should consult a board certified oculoplastic surgeon and make an informed decision based on your individual needs. Good luck

Kristin J. Tarbet MD, FACS
Bellevue Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Upper and lower blepharoplasty

A Browlift is not necessary since the distance between the eyelashes and eyebrows is acceptable. The primary goal of an upper  Blepharoplasty is to remove excess skin and a small amount of fat creating  the hooded look.
The primary goal of lower eyelid surgery is to remove the  3 fat pads on the lower lids through trans-conjunctival approach which create the puffy look. When patient's have excess lower lid skin a small pinch technique of lower eyelid skin is trimmed and closed with tissue glue.
For many examples please see the link the below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Nonsurgical Lower Lid Rejuvenation Combined With A Nonsurgical 3D Vectoring Browlift --Simple Options For Improving The Eye Unit

Many of the changes we typically encounter in the lower lids with the passage of time--namely tear trough deformities, hollows and bags, result from shrinkage, shriveling, and a downward descent of the once robust, heart-shaped fat pad that sat immediately under the lower lids and extended out toward the temples, inward toward the root of the nose, and downward about half-way to the angles of the mouth. Although these changes are most often seen after age forty, genetic factors and a history of cigarette smoking and sun exposure may hasten the onset of these problems.

The loss of this volume and its downward displacement in the direction of the jaw (due to weakening of the supporting ligaments and the downward pull of gravity) elongates the lower lid to several times its narrow youthful width and leaves it somewhat sunken. In addition, like a balloon having lost its air after being fully inflated for a long while, the skin of the lower eyelid fails to snap back to its youthful smoothness, and instead remains crinkled and baggy.

Today, we can address these problems nonsurgically with the injection of fillers and volumizing agents to restore the volume to the lower lids and recontour them, and mask the bags. A variety of have been tried for these purposes. My personal favorites for dealing with tear troughs--for providing overally smoothness, shape and lift-- are the recently approved Belotero Balance and Restylane L.

In my experience, while more prominent bagging may be improved considerably with this approach, some degree pf bagging typically persists following treatment. On the other hand, for mild to moderate bags, it usually takes about five minutes to treat each lower lid with immediate that typically evoke a "Wow!" response from patients when they look in the mirror.

While minimal bruising, tenderness, swelling and redness may occur following treatment in this delicate region, these are usually temporary and disappear spontaneously within one to seven days. Most people can return to work or social activities immediately or the following day and coverup may be used if desired.

In cases where a nonsurgical lifting of heavy brows is desired or more appropriate than surgery, a totally non-invasive approach, the Nonsurgical 3D Vectoring Browlift, might be considered. The technique is analogous to that used for performing the Nonsurgical 3D Vectoring Facelift and the Nonsurgical 3D Vectoring Necklift. Optimal lifting is best achieved with the injection of volumizing fillers, such as Radiesse or Radiesse combined with Juvederm Ultra Plus XC, . The principle for this approach is exactly that of the other two procedures mentioned, i.e. to reverse the downward deflationary vectoring of the aging (the sagging) brow with an upward and outward flare to the brow.

The injection technique is quite simple and takes only minutes to perform and yields results that are both immediate and longer term (improve over the next six to eight weeks) as neocollagenesis (new collagen formation) occurs where the volumizer was injected that leads to further retraction and benefit. Owing to its simplicity and lack of downtime, this treatment makes an excellent nonsurgical browlift option for people of any age. If needed, the brow elevation may be further enhanced by the instillation of a few droplets of a neuromodulator, such as Botox, Dysport or Xeomin.

Naturally, consultation with a board certified aesthetic physician experienced in each of these techniques is a must.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

Upper and Lower Bleph with Brow Lift

Hi Foursonz,

Initially, you consulted for lower blepharoplasty which to me means that you are not actually concerned much about your upper eyelids and brows, until it was recommended.
Based from your photos, you will definitely benefit from conventional lower blepharoplasty. 
For the other procedures, in my opinion, it is the lateral (outer) end of your brows and upper lids that looks heavy and droopy while the medial (inner) ends are still acceptable though they also show slight drooping. 
Another option aside from doing upper blepharoplasty and brow lift is temple lift, however, only a personal consultation will determine which approach will be best. 

Somyos Kunachak, MD
Thailand Facial Plastic Surgeon
4.7 out of 5 stars 17 reviews

Lower bleph, upper bleph and brow lift?

It appears as though you would benefit from an Upper and Lower Blephroplasty.  As for the brows, typically the brow should be a finger width above the bone and yours are a bit low.  In my opinion, you are a candidate for all 3 procedures.  If you did not want to perform the browlift, you would get about 50% reduction in the benefit of your upper eyes.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Eyelid ageing

It is hard to tell from the photos exactly what would be right for you, but it appears as if y ou could benefit from a 4 lid blepharoplasty. The lowers could be done without a visible scar. An in person consultation would be needed to be sure regarding the position of your brows, but from the photos they seem to be OK.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Brow lift and 4 lid blepharoplasty

I think that you have to be seen in person to provide adequate evaluation of the upper 1/3 of your face.  4 lid bleph and brow surgery can go hand in hand.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Bleph v brow lift

Unfortunately, the photos do not show the condition of your brows.  In some patients, the apparent upper lid redundancy results from the brow sag and the upper lid bleph can be avoided; in others, the bleph is necessary.  Given your age and whatever I can discern from the photos, I would tend to recommend the 4-lid bleph now and defer the brow surgery.  I do think that you need all 4 lids done for an optimal result.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 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.