Can Excess Skin Between Brows After Eyelid Surgery Be Resolved?

I had upper and lower Eyelid surgery, Facelift and Botox on my forehead 3 weeks ago. I didn't want the Eyelid surgery but my doctor insisted. The eyelids are very droopy and there is a wide gap between my eyes, and sagging skin from the inner eye area and between my brows through upper bridge of my nose. I know I need to wait but what might my options be if this does not improve? I'm in my early 40's.

Doctor Answers 14

Difficult problem to address

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If there is excess skin between the eyebrows this is a very difficult problem to address. A forehead lift can be performed usually only if there is preexisting low eyebrows. The thin skin closest to the nose on the eyelids is very difficult to remove without dragging the incision too close to the nose, which can create an obvious scar or webbing on the eyelid incision.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Botox and eyelid or eyebrow surgery

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Botox injections may influence results in the immediate postoperative period after Blepharoplasty. It sounds as though a brow lift was indicated at the time of your eyelid surgery but this can only be determined after the influence of Botox has worn off and the postoperative swelling subsides from your blepharoplasty. I would recommend that you wait several months before initiating any therapy.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Brow Lift

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If the distance between your eye appears to me worse now than when you were younger than there is an issue with the medial brows. Botoxing the corrugator muscles (between the brows) will allow the brows to move laterally if there is laxity in the tissue. This will give the appearance of wider eyes. I agree that once the Botox has worn off consider a brow lift without corrugator resection.

Botox may have influenced or affected surgical result

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I would highly agree with my colleagues that you may benefit from a forehead lift but It would be wisest to wait for the Botox to wear off (3-5 months) prior to making any final decisions.

Stick with your surgeon and give it some time.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Too early to tell if a forehead lift is needed

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It is probably too early to tell if a forehead lift will be necessary. The relaxation of your forehead muscles by the botox has clouded the overall situation. As the botox wears off over the next 3 - 4 months you will need to be rechecked. If the condition is still present then a brow lift may be your next best option.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Generally not a good idea to have BOTOX and eyelid surgery at the same time.

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Dear Notperfect

You kind got the blue plate special here.

It is quite possible that if you did not have both upper eyelid surgery and BOTOX at the same time you might be relatively satisfied with you results.

It is very important to understand that when the upper eyelid fold is heavy, the brain sends a signal to the forehead to lift the eyebrows. 100 percent of the time, when upper blepharoplasty is performed there is less need for the forehead muscles to work. They relax and the eyebrow comes down a little bit. Generally the overall effect is actually helpful because the relaxed brow is better for our appearance unless the fall in the eyebrow is a little too much.

Now, what does the forehead BOTOX do? It also relaxed the muscles in the forehead that lift the eyebrows. So no forehead lines but the brows go down. So between upper eyelid surgery and the BOTOX treatment, you have a double reason for the brow to fall. When the brow falls what you see is too much skin below the eyebrow.

Now the surgeon who answer questions here on are generally very supportive of what other surgeons do. However, I think that the combo of the BOTOX and the upper eyelid surgery is not ideal. Should you rush out and do something? Do you need a surgical forehead lift? The answer is no. That BOTOX will wear off and when it does your eyebrows will go up reducing the amount of skin you are seeing. So try not to be too annoyed--things will get better!

Dr. Steinsapir

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

You may need a brow lift in the future.

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The face heals quickly, and at 3 weeks, you should be looking better than what you describe.  Of course, I can't see what you look like, but unfortunately you may well need a touch up.

Don't do anything for 6 months.  If you are not happy then, one of the various brow lifts may help.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Not perfect and not healed...yet

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Dear Not,

As you mention in your question, you have to wait. The Botox treatments throw in an extra variable to support that dictum. Now, you not only have swelling distorting things, you have the paralysis associated with the Botox treatments. This would explain the lateralization of your brows. You really need to be patient and continue close follow up with your surgeon. You won't have a realistic idea of your result until 6 months or so from now. Good luck!

Swelling and Botox may be part of problem

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The brows being far apart is likely due to the Botox. Also the slight drop in the medial brow from frontalis paralysis which can happen with Botox may also be contributing. Finally, you need to wait for the swelling to go down to see final result from upper lid blepharoplasty, especially if a significant medial fat pad was removed. So be patient, and stay in touch with your surgeon for reassurance.

Extra skin is due to a loss of volume with aging

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This extra skin is a consequence of reductive type of surgeries. When you age, you lose volume and this contributes to the extra skin. Upper eyelifts / blepharoplasties take away skin and that usually leaves skin elsewhere. It won't end. A better way to rejuvenate the upper eyelids is to volumize the whole area. This will require fat grafting and on occassion facial implants.

The extra skin between your eyebrows is a normal part of aging that can be accentuated with reductive type of procedures. This area may need to be filled in to plump up the deflated state. This will fill in some of the wrinkles and excess. There are doctors out there that can think outside of the box to give people a more younger and natural appearance.

Philip Young, MD
Bellevue Facial Plastic Surgeon

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.