Appropriate Eyelid Procedures For 50 Year Old With Heavy Hooding? (photo)

Hello!. I am 50 years old woman and i would like some medical advice. Would a simple upper eyelid blepharoplasty be enough to correct the excess fat and the heavy hooding on my lids or should i also consider other alternative treatments like a brow lift? Thank you.

Doctor Answers 13

Functional eyelid surgery

Hi Ino,


That is some significant hooding and laxity you have there.  You'd benefit from both a brow lift and upper eyelid blepharoplasty.  You would heal within a week but it would be another 1 to 2 weeks before your incisions are inconspicuous.  


I should point out that if your eyelid laxity is bad enough it may be covered by insurance as you may have a visual field deficit.  Make an appointment with an ophthalmologist or an Oculoplastic surgeon to be evaluated.


The brow lift or Botox for brow elevation would not be covered, of course.


Thanks for the question.  Hope that helped.


Chase Lay, MD

Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 76 reviews

Upper Eyelid Surgery alone, or with Browlift?

A good way to determine whether someone ought to undergo a browlift at the same time as an upper eyelid operation is to determine where the eyebrow is in relation to the underlying bone.  In what is considered a nicely aesthetic eyebrow, the outer end of the eyebrow is about 1/2 inch above the upper rim of bone of the eye socket (the superior orbital rim).  If the tail of the eyebrow is at the level of the bony rim or even below it, it's probably best to seriously consider a browlift at the same time as the upper lids are done.  These decisions will vary, of course, with each person but this is an easy thing to check and then discuss with the surgeon you visit with about eyelid surgery.

Kelly R. Kunkel, MD
Fort Worth Plastic Surgeon
4.9 out of 5 stars 30 reviews

Appropriate eyelid procedure for heavy hooding

If the main concern is hooded and puffy upper eyelids, the best option is an upper blepharoplasty.  The goal of a brow lift is to soften the vertical creases between the eyebrows, elevate the eyebrows to make them look more symmetrical, (especially when one eyebrow is higher than the other).  The brow lift involves an incision in the scalp through which the adjustments to the eyebrow position and eyebrow muscles are made.  Both of these procedures are performed under general anesthesia in an outpatient setting.

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

Eyelid Blepharoplasty Canidate

Thank you for your photos. I think you would do well with upper eyelid blepharoplasty. Artistic removal of  the excess skin will restore the true shape of your eyes.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Appropriate Eyelid Procedures For 50 Year Old With Heavy Hooding?

An upper eyelid lift (blepharoplasty) would remove the redundant skin on your upper lids.  An incision is made in the crease of your upper lids and a wedge of skin is then removed.  You could also consider a brow lift to futher open your eyes and correct symmetry of the eyebrow position and also to minimize the furrow between the eyes by clipping part of the muscle.  Lower eyelid surgery is also an option to remove the fat pads and tighten the skin.  

Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon
3.3 out of 5 stars 9 reviews

Upper blepharoplasty

Upper eyelid droopiness can be due to 1)excess upper eyelid skin or 2)brow drooping or 3)a combination of these 2 processes. All are a natural part of the aging process. It is really a spectrum with only eyelid skin excess at one end & then increasing brow drooping up to only brow drooping at the other end. To see where you lie in this spectrum you can look in a mirror while elevating the eyebrow to a point 5mm above the bony rim above the eye. If the entire droopiness resolves then it is only due to brow drooping. If there is a 50% improvement then the problem is due half to excess eyelid skin & half to brow drooping, etc.

The only treatment then is surgical removal of the excess eyelid skin &/or surgical lifting of the brow. In some cases the problem can be so severe that the visual field is partially obstructed. Because your upper eyelid skin hangs down onto your upper eyelid eyelashes it is highly likely that you have some visual field obstruction. In such cases health insurance companies will cover the removal of excess eyelid skin after a visual field test shows the obstruction. Your surgeon will need to submit documentation in order to get preauthorization for the surgery from your health insurance company. Unfortunately they usually do not cover brow lifting even if the brow drooping is severe enough to obstruct the visual field. If eyelid skin is removed when a brow lift is required the brow will be pulled down towards the eyelashes compounding the problem. You also have significant left right asymmetry that needs to be accounted for when planning surgery.

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 2 reviews

Treatment of eyelid hooding is either by blepharoplasty or endoscopic brow lift.

Just like it says, a brow lift will lift your brow. It may help make your upper eyelids look better but it may raise your eyebrows too much. Blepharoplasty will remove excess skin of the upper eyelids. Some people need both. During a consultation both can be demonstrated to see which is best for you.

Some people get a nice improvement in brow height from Botox but this is certainly not as effective as surgery.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 126 reviews

Appropriate Eyelid Procedures For 50 Year Old With Heavy Hooding?

Thanks for the posted photos. Easiest operation combination is upper lid blepharoplasty with BOTOX. Seek in person evaluations. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Correction of the upper eyelid hooding

Based on your photos, you have a both brow ptosis and upper eyelid skin excess which is accentuated by brow ptosis. Also, your right brow seems to be lower than the left, which explains larger skin excess over the right upper eyelid.  While it is possible to achieve a good improvement by blepharoplasty alone, a combination of blepharoplasty and brow lift will give you the better result.

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

Upper third of face issues

It looks like from your photos that you have significant upper eyelid hooding from brow descent.  A proper evaluation in person would certainly be helpful.  A brow lift and upper and lower eyelid surgery may be the best solution for you.    Good luck.

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