36, female. Do I need an upper blepharoplasty or brow lift? (Photos)

Thank you for your photos. Your brow appears to be in good position and elevating it higher would not benefit you. Your lateral canthus appears to have a slight upward tilt, giving a beautiful accent to your eye shape. The loose skin of your upper eyelids could easily be corrected with an upper blepharoplasty, performed under local anesthesia. This will remove the redundant skin of your upper eyelids and the hooding. Everyone has some degree of asymmetry, however, to get your eyelids as close to equal as possible, careful caliper measurements of where to place your incisions and the amount of skin to remove, would be performed. The number of millimeters of excess skin to be removed varies between patients as well as between eyelids and depends upon your specific anatomy. An upper blepharoplasty should make you look more alert and energetic.

If you see surgeons and ask for a blepharoplasty or mini brow lift, likely that is what you are going to get. I do wish that instead they would perform a true evaluation, understand what you are looking for, and the discuss your best options and what they recommend. Sadly that seldom happens. Instead one often gets an abbreviated evaluation before they agree to perform one or both of the procedures you requested. Often the results are surprising. Your posted photos give several significantly different looks. In all photos you carry your eyebrow relatively high suggesting a compensatory eyebrow elevation. The eyebrow compensate when there is slippage of the tendons in the upper eyelids. In the second picture, your brows are more relaxed and the upper eyelids look heavy, which is consistent with ptosis. A detailed assessment is warranted to determine if your real issue is upper eyelid ptosis with brow compensation. In that case the fix is a conservative anchor blepharoplasty and ptosis repair. Assuming you do have underlying upper eyelid ptosis and the other picture are just you compensating for the ptosis, mini brow lift or blepharoplasty alone will fail to address the underlying problem and the outcome will be unsatisfactory. If you see someone and they do not talk about these issues, I recommend getting help elsewhere.

Based on these photos, it is very likely that both upper blepharoplasty and endoscopic brow lift should be considered. In person or teleconference evaluation with a board certified plastic surgeon with experience in these procedures is recommended. Good luck.