Would You Recommend Fillers or a Brow Lift For My Tired Appearance? (photo)

I'm 45 and would like to look less tired. I'm considering fillers for the tear trough -my main area of concern- but also I see how low my brow is and the asymmetrical drooping of my upper eyelid (shared by my older relatives). I'm not sure I'm ready for a big procedure like a brow lift - I'm scared of looking like a deer in the headlights. Do you think I could benefit from just fillers, or would I need surgery to really make the look work?

Doctor Answers 7

Tired Look

Based on your photos, you appear to be a better candidate for fillers and ptosis repair. Opinion will be split. Therefore, you will be best off consulting in person with 2 - 3 board certified plastic surgeons.

West Palm Beach Plastic Surgeon
4.5 out of 5 stars 39 reviews

Brow asymmetry and tired look

As far the upper eyes are concerned you have upper eyelid ptosis, worse on the left side - correctable with ptosis repair not with upper blepharoplasty.  Your eyebrow on the left is trying to compensate for the ptosis and is lifting itself higher (see example on the link).  A brow lift may also be performed as long as you don't have a problem with dry eyes.

As far as the lower eyes I would recommend fat grafting and a lower blepharoplasty.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Fillers or surgery for brow and eyelid ptosis

Fillers would give you some temporary improvement in the lower lid area however temporary is the key word. From your photographs I personally think that you would benefit from an endoscopic browlift with upper lid blepharoplasty. When an endoscopic browlift is done properly it is not just raising the brows but giving you a mid face suspension at the same time. The entire facial unit is undermined, skin, muscle and soft tissue and then lifted and restored back into it's pre aging position. No skin is removed and it is done through small incisions in the scalp area. With the brows placed back in the pre aging position then the upper eyelids would be evaluated for the amount of skin to be removed and a small incision would be made in the upper eyelid crease and the excess tissue would be removed. The upper third of the face is typically the first signs where we see the aging process. Having these procedures would help you look less tired and give you a more youthful rejuvenated appearance. Most patients state they look the same way they did in their photos ten years earlier and this is the goal. If you go on my website you can see many photographs of browlift patients that have similar problems to yours pre surgery and you will see their post operative photographs that no one looks like "a deer in headlights." this is a very popular procedure with excellent aesthetic results. Look for a good board certified facial plastic surgeon in your area for a consultation and with a complete examination they should be able to guide you in the proper direction. While fillers may help minimize the appearance of some aging problems they can be costly and not highly effective when surgery is needed. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 208 reviews

Tired eye appearance

You don't need a brow lift.  Your tired appearance comes from droopy upper eyelids (ptosis) and the dark circles underneath your eyes.  Upper lid ptosis surgery and lower lid fillers (vs possible surgery) will improve your tired appearance. Consult with an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Tired appearance and browlift.

A browlift is the only permanent way to fix sagging brows. If you are ok with temporary fixes such as botox and fillers, then that will improve matters. You won't end up with a strange look if you see an experienced browlift surgeon!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Would You Recommend Fillers or a Brow Lift For My Tired Appearance? (photo)

Hi Freewheel.

There are several things going on making you look tired.  As you mentioned, the lower lids are a part of it and fillers could help.  The other thing is that your upper lids seem droopy (ptosis).  I am not sure whether this is only in the photo or an actual real phenomenon.  Your brows are asymmetric, but is this due to your upper eyelids drooping?  The best thing for you to do is see an experienced Oculoplastic surgeon to evaluate your eyelids for the best treatment recommendation. 

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Brow lift versus fillers

Here's my opinion on your situation:

1)  you said your tear trough was your main concern.  I agree with your assessment.   Fillers may help this.  You may also require a blepharoplasty for best results, but that's hard to determine without an examination.  See a local plastic surgeon to discuss these options.

2)  Even though the brow position is indeed slightly asymmetrical - your brow position is not particularly low.  A high brow position doesn't look natural, particularly on a man.  Therefore, I don't think you need a browlift, unless you are trying to improve the asymmetry, rather than the overall position - which is a different issue.


All the best,


Thomas Fiala, MD
Orlando Plastic Surgeon
4.9 out of 5 stars 79 reviews

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