Do I Need Blepharoplasty Only?

I am age 62, and have very saggy upper eyelids, extending slightly past the outer corners of my eyes. My doctor has recommended a blepharoplasty, bilateral levator advancement, bilateral direct brow lift, and bilateral sculpting of the upper lid fat pads. Since my insurance covers only the blepharoplasty, I'm wondering, do I need the rest. My eyebrows are not sagging, and I don't seem to have a lot of fat above my eyes, so do I really need the eyebrow lift and fat sculpting? Also, what does the "bilateral levator advancement" mean? Thanks so much for your help!

Doctor Answers 4

NonSurgical Browlift

Nonsurgical browlifts have become quite popular of late and may serve as an alternative to aggressive, invasive surgical browlifts in properly selected individuals. They are quick and easy to perform, have little or no downtime, and can achieve quite gratifying results in many cases.

The simplest form of chemical browlift is the Botox lift. Tiny droplets of Botox or Dysport are instilled in the region of the outer third of the brow in order to weaken slightly the downward pull on the brow of the muscles around the eye. This gives a competitive advantage to the upward pulling muscle of the forehead, which in turn results in an upward lift of the brow. In mild cases of baggy upper lids and sinking eyebrows, the improvement achieved may be enough to open up the eyes and make them appear wider.

When this simple technique does not prove enough, as in cases where the excess skin above the true upper lid sags considerably more downward upon the upper lid, the use of a volumizing agent may be helpful. In youth, a frankfurter-shaped fat pad sits directly under the outer third of the eyebrow and serves not only to impart fullness to the region, but acts as a support to eyebrow, as well, enabling it to flare outward and upwards. With age, this fat pad shrinks and sinks downward causing the outer third of the brow to fall and the upper lid to demonstrate redundancy.

A small amount of filler material, such as Juvederm or Restylane instilled in a football shape directly under the lower hairs of the outside one-third of the eyebrow serves to reinflate the region, provide a youthful projection to the brow, support the brow and restores the characteristic outward flare of the eyebrow. In addition, it helps to pull some of the excess skin off the underlying upper eyelid. When combined with Botox, the results of this "chemical browlift" can last for a considerable length of time.

New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Ptosis Surgery


I have to agree with the information that the other surgeons have provided. I recommend a levator advancement only when I make the diagnosis of ptosis...this is made using a functional analysis of your eyelids function. Occassionally, one eyelid functions better or worse than the other and can make the advancement procedure more complex. This may also be covered by insurance as it is a functional impairment that can be quantified objectively by your surgeon.

Men have "bushy" eyebrows and can conceal a direct excision scar...women have thin eyebrows and therefore may form a visible scar over the eyebrow. Plastic surgeons are fanatical about concealing and camoflauging incisions, this is why I typically place brow lift incisions high in the forehead, or better yet occassionally use the same blepharoplasty incision to plexy or lift the brow with either a suture or a tacking device (which desolves over 6-8 weeks).

In the last few years, plastic surgeons have demonstrated via CT scan evidence that eyelid and orbital fat decreases over time, so we are less aggressive with our fat removal. This may be the reason your surgeon has referred to his procedure as sculpting.

I think you need as many opinions as you are comfortable obtaining, face to face, with Board Certified Plastic Surgeons who perform a significant number of Blepharoplasties. Ask for result photos with a focus on patients Before photos that your surgeon indentifies as resembling your own anatomy.

I hope this helps and good luck!

Dr. C

John Philip Connors III, MD, FACS
Atlanta Plastic Surgeon
4.8 out of 5 stars 46 reviews

Need to see your problem

Not trying to be evasive but in order to make a suggestion that is accurate, any doctor would need to "see" the problem. Given your age, I would not be surprised if you would not benefit from a brow lift. You may also benefit from a Blepharoplasty. You should see some doctors in your area and also be able to express your expectations regarding your final result.

Michael Kulick, MD, DDS
San Francisco Plastic Surgeon
4.2 out of 5 stars 11 reviews

You should do what you are comfortable with.

Dear Linda

I hope that you are seeing an ophthalmologist who is fellowship trained in eyelid plastic surgery. This individuals will have been elected to the American Society of Ophthalmic Plastic and Reconstructive Surgery. Your doctor may truly believe that you need all of these things. However, it may be that they are looking to add cosmetic procedures that you will be financially responsible because insurance reimbursement for function blepharoplasty is now so low that it is almost not worth a surgeon's time to perform this procedure.

Levator advancement is a type of ptosis surgery. The tendon of the upper eyelid is shortened and then fixed to the upper eyelid platform to strengthen the effect of the levator palpebra superioris muscle that raises the eyelid.

I strongly don't advise a direct brow lift. This is a very unaesthetic procedure that places an ugly scar above each eyebrow. Also generally the sculpting of fat in the upper eyelid needs to be very conservatively and most eyelid surgeons would agree that this is part of the blepharoplasty even it it being done functionally.

I am going to encourage you to get other surgical opinions. I think that it is reasonable to to less but you may need the combination of procedures or it might be reasonable to only to some of the work. Take a look at the website. They have a directory of oculoplastic surgeons and this will help you find highly qualified surgeons in your area.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 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.