34 years old and unhappy with aging eyes: am I a good candidate for eyelid surgery or a brow lift? (photos)

Question

I’m 34 and I’m really unhappy with how my eyes have been aging. They have always been heavily hooded but recently have lost a lot of volume in the upper lid, in a very uneven way. One eye looks almost too hollow and has an extra fold, one just has a total hood over which now looks crepe-y. I actually miss my old hooded eyes when I had more fat in the area below my brow. Am I a good candidate for eyelid surgery or a brow lift? Are these things I should put off/ will have to redo later?

Kenneth D. Steinsapir, MD · Answer

It is all too common to ask for a belpharoplasty or a forehead lift and get precisely what you have asked for. You think your potential surgeon understands what you are looking for aesthetically and it is only after surgery that it will be clear that you did not communicate with your surgeon. Please do not do this to yourself; it is emotionally traumatic getting the wrong surgery. That "extra" fold in your left upper eyelid is your natural fold. You need your upper eyelid fold. It is a critical feature of your face. If you have an upper blepharoplasty, your potential surgeon will think that their job is snipping off that "extra" fold. Perhaps they will convince you that you need the fold in both upper eyelids removed. That will be a horrible thing to do because the surgery will skeletonize the upper eyelids. You will look much older and you will be very distressed by the change in your appearance. I know this because I spend a lot of my practice fixing this missing upper eyelid folds.

What is missing is anterior orbital fat. What happened to that fat? If you look at your photo, you can see that you have a small amount of left upper eyelid heaviness, which is called upper eyelid ptosis. You also have a compensatory left eyebrow elevation. The proper fix for this is to repair the slippage of the left upper eyelid tendon. Anterior orbital fat that normally fills that upper eyelid fold, tracks the slipped anterior levator tendon. It is possible to release this fat and allow it to also be repositioned lower in the eyelid with the tendon. This restores the volume in the upper eyelid. Blepharoplasty means eyelid surgery but this is not at all the type of surgery that most surgeons offer eyelid surgery perform. If you ask for upper eyelid surgery, you will get subtractive surgery where skin and muscle are removed. That will not be right for you. A brow lift will also be a terrible mistake for you and rob you of your youthful appearance. Help starts with a personal detailed consultation.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. While you don’t appear to be a candidate for a brow lift, you may benefit from upper blepharoplasty to correct upper eye volume and symmetry. This surgical procedure can define the creasing of both eyelids to bring them into balance with each other, as well as your other facial features, while also restoring volume where needed for a supple and youthful result. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They’ll be able to review your concerns and determine which treatment option may be best for you.

Jason Emer, MD · Answer

As we age, our eyelids naturally sag and droop. A combination approach would be best to see visible improvement. In terms of non-surgical treatment options, I would recommend a Chemical Brow Lift (using Botox, Dysport, Xeomin, or Jeuveau) and filler injections to rejuvenate the temples, eyebrow, eyelid, eye troughs, upper eye hollows, and forehead. I typically combine this with Ultherapy and thread lifting to lift the brow; RF and skin tightening laser treatments to stimulate collagen production and rejuvenate the skin; and laser or superficial RF devices for improvements in texture, color, and any crepey skin around the eyes as needed. In some cases, surgery is the best solution to achieve the desired results. See an expert for a formal consultation. Best, Dr. Emer.​

Leyla Arvas, MD · Answer

Yes aging makes the assimetry look more visible, upper eyelid surgery or Temporal eyebrow lift can be a permanent solution for some years , but as we age the revision surgery may be needed in future, as ptosis is a thing that keeps going as we age . On personal examination we may propose you combination treatments both surgical and none surgical , like Laser treatment to improve and lift your skin, we use Fotona 4 D laser for that purpose.

Mehryar (Ray) Taban, MD, FACS · Answer

I believe you are candidate for conservative upper blepharoplasty. You do not brow lift. Important to have personal evaluation for accurate treatment plan. See an expert.

34 years old and unhappy with aging eyes: am I a good candidate for eyelid surgery or a brow lift? (photos)

Answers (6)

Answer: Eyelid surgery or a brow lift?

Answer: Eyelid surgery or a brow lift?

Answer: Upper blepharoplasty

Answer: Upper blepharoplasty

Recommended reading

Everything you need to know about Eyelid Surgery

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34 years old and unhappy with aging eyes: am I a good candidate for eyelid surgery or a brow lift? (photos)

Answers (6)

Answer: Eyelid surgery or a brow lift?

Answer: Eyelid surgery or a brow lift?

Answer: Upper blepharoplasty

Answer: Upper blepharoplasty

Browse related questions

Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.