I hate my drooping eyelids, I wasn’t sure if I need a brow lift or Blepharoplasty or laser surgery? (Photos)

Question

I am very conscious about my upper eye lids. When I was around 17 I had an issue with bad dry skin and I used some topical creams as I’ve got order the skin just appears to sag and when I look up I sometimes feel the fold flap. I am 37 and wondered what is the best thing to do?

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

A formal assessment in consultation will give a few answers in relation to:

- The shape of the upper eyelids when the brow is repositioned
- The degree of upper eyelid exposure that you would see is aesthetically pleasing

Upper eyelid surgery is definitely able to produce significant change for the impression that there is excess skin. It has to be used carefully also to avoid hollowing the eyes.

The photographs suggest a slight slanting downwards of the lateral part of the eyebrows and elevation of the lateral brow often improves the appearance of the upper eyelid skin.

Laser surgery is probably least likely to produce sufficient change in your situation.

Russell Bramhall, MBChB, FRCS(plast) · Answer

Hello,
Thank you for your question. Laser doesn't tend to do much here so would be best avoided. As would any cream that someone tries to sell you to tighten the eyelid skin. None of it really works. It's a bit difficult to tell from the photos, but it seems like you have slightly low eyebrows (mild brow ptosis) and some excess upper eyelid skin (dermatochalasis). The former is correctable with a brow lift. However, brow lifts are much less popular today. This is because none of the techniques are perfect. Direct brow lifts put a scar directly above the eyebrow, which is quite noticeable and people don't tend to like the scar. Endoscopic brow lifts are usually done under general anaesthetic, involve scars in the hairline which can be quite obvious in men if they later lose hair in these areas, and also usually involve drilling into the bone to re-secure the skin higher up. The main alternative is a trans-blepharoplasty brow lift through the same scar as an upper blepharoplasty. The scar is then better hidden. You still need to drill into the bone though and then usually use some sort of hard screw into the bone that gradually dissolves over the next 6 months. People often don't seem to like being able to feel the hard screw through their forehead skin for this period. The results also don't always last longterm and the brow ptosis can recur.
Many people in your situation would therefore decide to do something simpler by accepting their brow position and improving the appearance just by removing the excess upper eyelid skin. It's important to fully appreciate the differences between these two decisions though as if the eyelid skin has been removed and it was really the eyebrow lift that you were looking for, lifting the brow later isn't always possible as there then wouldn't be enough upper eyelid skin for you to safely be able to close your eyes.
It's definitely worth taking your time on this, doing plenty of research and then going to see a surgeon who deals with lots of similar patients for a full examination and detailed discussion about all your options. 
Good luck with it all anyway!
Russell

Samuel Mattine, MBChB, MRCS, FRCS · Answer

You have moderate degree of excess skin in combination with mild ptosis of the upper lids. In my opinion, in light of the amount of excess skin and ptosis, you are unlikely to get a reasonable improvement with Laser alone. I personally feel you would have a better outcome with upper blepharoplasty, with the ptosis being addressed simultaneously .

Kenneth D. Steinsapir, MD · Answer

The right upper eyelid is heavier that the left and you have a stronger compensatory eyebrow elevation. You have a thin eyelid due to central disinsertion of the levator aponeurosis. This condition is likely unrelated to your dry skin in the past unless you were a chronically manipulated your eyelids. Simply blepharoplasty and forehead surgery are not right for you. You need an anterior levator resection ptosis surgery. Likely you need bilateral surgery. There are two commonly performed ptosis procedures: mueller's muscle conjunctival resection ptosis surgery and anterior lavator resection ptosis surgery. The Mullerectomy is very popular with surgeons, it is quick, easy and predictable but it is not right for you. It is very ineffective for central levator disinsertion. If you have this type of surgery, you will be under corrected. A detailed personal assessment is needed to determine what surgery is best for you. That information is not gathered during a Zoom consultation.

A.J. Amadi, MD · Answer

The most important feature that your photos demonstrate is your upper eyelid ptosis (droop) which is worse on the right than the left. The droop eyelid is causing you to subconsciously elevate your eyebrows, again the right one more than the left. Addressing the eyelid ptosis is the most important part of your surgical plan, because it will allow your brows to settle to the normal anatomic position. It is possible that you may also require an upper blepharoplasty. 
Seek a consultation with an Oculofacial Plastic Surgeon (Oculoplastics). Although some astute general plastic surgeons appreciate and occasionally treat eyelid ptosis, they usually do not have expertise in ptosis surgery and you may end up having surgery that does not address your problem. 
Good luck.

I hate my drooping eyelids, I wasn’t sure if I need a brow lift or Blepharoplasty or laser surgery? (Photos)

Answers (9)

Answer: This is bilateral upper eyelid ptosis with a compensatory eyebrow elevation.

Answer: This is bilateral upper eyelid ptosis with a compensatory eyebrow elevation.

Answer: Eyelid Ptosis

Answer: Eyelid Ptosis

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.

I hate my drooping eyelids, I wasn’t sure if I need a brow lift or Blepharoplasty or laser surgery? (Photos)

Answers (9)

Answer: This is bilateral upper eyelid ptosis with a compensatory eyebrow elevation.

Answer: This is bilateral upper eyelid ptosis with a compensatory eyebrow elevation.

Answer: Eyelid Ptosis

Answer: Eyelid Ptosis

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.