45 years old - Brow lift for asymmetry and/or blepharoplasty? (Photos)

Question

I've had two consults with oculoplastic surgeons for blepharoplasty. One didn't recommend a brow lift and the other said he could do an endoscopic lift. I didn't ask about asymmetry but was once told by a surgeon that brow asymmetry usually returns. Would I benefit from a brow lift and could it make them more symmetrical? Or is it better to leave the brow alone for now? I'm 45 years old.

Lexie Wang, MD · Answer

I think you are a borderline candidate for the brow lift. The reason that it may have been suggested to you is that you have a downward tilt of your eyebrows, kind of like a sad puppy eye, which typically is not a look that most people have and is associated with aging (the tail of the brow comes down first). However, it looks to me like your brow position is actually fine in terms of its location on your frontal bone and also given that you don't have much hooding past the eye. I think a brow lift would probably change "your look" too much than what you'd want.

Gary M. Horndeski, MD · Answer

You will need a brow lift to correct the asymmetry of your eyebrows.  A blepharoplasty will not correct the asymmetry.

Best Wishes,

Gary Horndeski, M.D.

Lucian Ion, FRCS · Answer

Thank you for your question. In general, an endoscopic brow lift can improve eyebrow symmetry to a degree. However, it is important to recognise that perfect symmetry is rarely achievable, partly because the underlying bony orbits themselves are not positioned at exactly the same level.

In most individuals, brow asymmetry is moderate and often influenced by differences in muscle activity. If one side has a tendency to depress or elevate more strongly, that dynamic imbalance can gradually reassert itself over time, even after surgical correction. This is likely what your previous surgeon was referring to.

In such cases, botulinum toxin can be helpful in maintaining symmetry by reducing the activity of the more dominant side, whether it is pulling the brow downwards or elevating it excessively. We often assume that facial muscles function symmetrically, but in reality they rarely do. In fact, natural facial expression is typically somewhat asymmetrical.

Another factor worth considering is that emotional expression is influenced more strongly by brow position than by the eyelids. A brow lift can therefore alter not only symmetry but also the overall character and openness of the expression.

45 years old - Brow lift for asymmetry and/or blepharoplasty? (Photos)

Answers (3)

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