Am I good candidate for an upper bleph? (Photo)

Question

I am 35 and I am interested in an upper bleph. I do get Botox but I have to be very careful with forehead treatment. I tried a "Brow lift" with Botox and it made my ptosis worse. In these pictures I am 2 months out from my last Botox treatment with only 3 units placed in hair line, none around the Brows

C. Blake Perry, MD · Answer

You would be a candidate for upper eyelid surgery (blepharoplasty). You will need an inperson consultation to consider micro-ptosis surgery as well. Best to see an eyelid expert.

Osman Halit Cam, MD · Answer

Hi there,According to the pictures you submitted, you are a good canidate for eyelid surgery after a few years later. Botox treatment to the frown lines and crow feet at the same time is the gold standart to keep eyelids fresh. Solo forehead botox treatment is most likely to result with tyred eyes. With this strategy you will gain more time for your uper lid surgery. Also you have excess skin in one eye in comparison to another. Bye.

Marc Polacco, MD · Answer

Thank you for your question. Based on your photos, you don't have a ton of excess upper eyelid skin. There's some, but given this a brow lift (especially laterally) would probably be a better option. These procedures are often used in combination as well. I hope that's helpful, and all the best.
-Dr. P

Mehryar (Ray) Taban, MD, FACS · Answer

Yes you are good candidate for upper blepharoplasty pending more detailed evaluation. Technique is important to have natural results. See an expert.

John Michael Thomassen, MD · Answer

The Botox may have played a role in dropping your brows and making the excess skin on the upper eyes more noticeable.  You may want to wait the 3-4 months total for Botox to wear out.  If you still notice it when you have full frontalis (forehead) muscle function, you may consider an upper blepharoplasty.  It is a safe and reliable procedure to remove excess upper eyelid skin with quick recovery and high patient satisfaction done under local anesthesia in the office.

Tanya T. Khan, MD · Answer

Hello, yes you do appear to have some excess skin along both upper eyelids that is causing hooding as well as possibly a small degree of ptosis. This would be best corrected with a combined upper blepharoplasty +/- ptosis repair performed by an experienced oculoplastic surgeon.

Kenneth D. Steinsapir, MD · Answer

To help you understand why, let's analyze what is going on with your upper eyelids and eyebrows. There is no substitute for an in person consultation.  You have bilateral upper eyelid ptosis with redundant upper eyelid creases and a relatively hollow and high upper eyelid sulcus. There is also a compensatory eyebrow elevation. You basically have an innie eyelid which I call a synform fold eyelid. You have upper eyelid lash ptosis. You have relatively long eyelashes. If you are using an eyelash growth serum on either your eyelashes or eyebrows, stop this immediately. These product kill eyelid and eyebrow fat. Standard blepharoplasty, and many eyelid surgeons would perform standard blepharoplasty, will not address your issues. Standard blepharoplasty removes skin, muscle, and fat. This will skeletonize your upper eyelid by removing the skin of the upper eyelid fold in a misguided effort to "clean up" your upper eyelids. It does not address your upper eyelid ptosis. Your upper eyelid is relatively hollow most likely due to a central levator disinsertion that is also causing the upper eyelid ptosis. With the retraction of the levator aponeurosis into the anterior orbit, anterior orbital fat that normal contributes volume to the upper eyelid fold, also retracts back into the orbit. An upper eyelid fold gets volume from one other source and that is the skirt of fat that hangs down from the eyebrow area. Upper eyelid ptosis stimulates the frontalis muscles to raise the eyebrows. That means that this modest contribution to the upper eyelid fold is not available making the upper eyelid fold appear more depleted. The best solution to your issue is to not skeletonize the upper eyelid (which will suddenly make you look much older) rather the best solution is to fix the upper eyelid ptosis and restore the volume to the upper eyelid fold, you will also benefit from an anchor blepharoplasty. At consultation, you also need to be assessed for lateral canthoplasty which might also need to be part of your restorative eyelid surgery. This type of surgery is best done under light intravenous sedation. Do not get the wrong surgery. Fixing a stardard blepharoplasty is never as good as getting the right surgery in the first place. Your eyes can be your best feature.

Camille Cash, MD · Answer

From your photos it appears you are a good candidate for an upper blepharoplasty.  This will remove excess upper lid skin to give you a fresher look.  See a board certified plastic surgeon near you to learn more.

Bruce K. Smith, MD · Answer

For many the first sign of aging is around the eyes and therefore, upper lid blepharoplasty is the first plastic surgery considered by many patients to address aging changes. Much of the redundant thin skin in the upper lid can be the result of heavier brow skin falling into the upper lid. This appears to be the case in your situation, but this can only be determined with a consultation in person. With even small amounts of descent of the thicker brow skin centrally, it can create the appearance of sadness, anger or aging. You may be a better candidate for a limited brow lift. This can only be determined in person and when the Botox effect has completely resolved.

Robert Singer, MD · Answer

Fullness of the upper lids can be cosmetically improved with a number of surgical options depending on individual anatomy and desired outcome: an artistically performed conservative upper blepharoplasty, a repositioning of the brow if it is low, or a combination of both.

Following the advice of anyone who would presume to tell you what to do based on a limited photos and more importantly without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest.  Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Am I good candidate for an upper bleph? (Photo)

Answers (13)

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