What causes droopy lids and brows, and is upper bleph the right choice for me?

I have droopy brows and eyelids due to genetics, thick skin, and aging (I'm 30). I'm interested in upper bleph/botox. What are the risks, since I get the sense the problem is aging of head/lid muscles,not just sagging skin? Is this the same as dbl eyelid surgery, with the same risks? What are the risks down the line for upper blepharosty for the functioning of my eyelids (blinking/closing) &dryness? How can I tell if eyelid surgery alone will meet my needs? Can botox for the brow suffice?

Doctor Answers 10

Upper lids and brows drooping at a young age

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Rather than genetics specifically being the issue, it's probably more bony structure and soft tissue weight. Upper eyelid lifts are generally effective for all people, unless extreme brow ptosis is present, which I suspect you do not have, since you are 30 years old. Dryness can occur. If concerned, have a Schirmer test done prior to surgery to check your baseline tear production. As long as your surgeon doesn't remove too much skin, there should be no problems with eye closure now or in the future. Posting photos will help me answer the question about the brows. 

Seek Expert Facial Plastic Surgeon for Eyelid Surgery

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You can answer your last question by getting a Botox lift and seeing if it opens your eyes sufficiently. From your description, however, it sounds like you might benefit from blepharoplasty and possibly a slight brow lift. The risk for adverse outcomes such as dysfunctional eyelids and dryness can be minimized by finding a facial plastic surgeon who has expertise treating the eyes. You need to be evaluated in person. I hope this helps.

Eyelid/Brow rejuvenation options

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These are all great questions and without pictures or an examination, it will be difficult to guide or suggest. Send some pictures for better clarification of exactly what is going on as you are young so options will vary. 

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Consultation is best way to answer those questions

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  • There are pros and cons to every decision we make.  It is difficulty to know how to advise without seeing someone in consultation or at least seeing a photo.  

Droopy eyelids

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These are all good questions, but an exam in person is essential to determine what might be right for you. Good luck.

Droopy eyelids and eyebrows at age 30

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A full set of photographs are required to make a determination about a surgical procedure.  For many examples of brow lifts and eyelid surgery, please see the link and the video below 


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Hello and thank you for your question. These are very commonly asked questions by patients.  The answer depends on your individual anatomy.  The best advice you can receive would be from an in-person consultation.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

What causes droopy lids and brows, and is upper bleph the right choice for me?

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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.

There are multiple options available for a patient with your anatomy: Upper lid blepharoplasty alone, endoscopic brow lift, limited lateral brow lift, forehead lift, neuromodulators like Botox or Dysport, hyaluronic fillers, or a combination of procedures. There is no one best option. It depends on your desired outcome and understanding of the pros and cons of the various procedures. 

It is important to realize that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without seeing photos but more importantly without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Facial rejuvenation needs to be individualized. What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the various options that can achieve the best cosmetic result for you.

Robert Singer, MD FACS

La Jolla, California


Your eyelids

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You need to be seen in person to know what will work for you and then I can answer your questions. Without a photo I don't know what your main issues are and the treatment varies. 

Neuromodulators, Volumizing Fillers & The Ten Minute Eyelift All Work For Lifting The Brow & Lids

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Without photos, it is really difficult to say which procedure or combination of techniques would be best in your particular case. What I can say is I personally suffer from the same genetic predisposition to droopy lids and brows that you describe. For myself, being considerably older than you, I was required to treat myself with a combination approach of neuromodulators (in my case Botox) to soften the downward pull of the depressor muscles of the brows; the use of a volumizing filler for a nonsurgical eyelift (Princess Volume, which I use in my Israel satellite facility) and The Ten Minute Eyelift, a minimally invasive procedure that engenders little post treatment downtime for reducing redundant and droopy upper lid skin. (In my Upper East Side Manhattan practice, I would use Juvederm Ultra Plus XC for the nonsurgical eyelift.) For more information on any of these, check out the archives of RealSelf.com, and be sure to seek consultation at a board certified, aesthetic physician with experience and expertise in nonsurgical and minimally invasive eyelid rejuvenation. And, of course, make certain to see his/her before and after photos. Best of luck to you from someone who has been in the trenches along with you with this problem. 

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.