I am 58 yo. with very dry eyes. Is a Brow Lift a much safer option than Blepharoplasty?

Before undergoing any procedure please have an ophthalmic evaluation.  In my experience dry eye worsening is much more common after blepharoplasty than brow lifting.  However, it can occur with both.  There are ways to assess your corneal (ocular) protective mechanisms which will allow an assessment of your candidacy for surgeryBestDr. Massry

Upper eyelid blepharoplasty can be safely performed if it is conservative enough, to be sure the eyelids close easily.  A browlift can sometimes give a better cosmetic result than a conservative blepharoplasty.  With appropriate care, either can be performed

It is best to get what you need and not have what you don't need.  A brow lift may or may not be your best option.  It is possible to do a skin only blepharoplasty.  This does not damage or weaken the orbicularis oculi muscle that closed the eyelid.  This muscle is often weakened as part of the blepharoplasty and that is what causes or contributes to dry eye following blepharoplasty. Proceed with caution and be very careful about being talked into a surgery that is not right for you.

But a brow lift and upper lid bleph are not interchangable operations. If you have significant upper lid hooding, I would do the bleph but would be conservative in the amount of skin resected. A brow lift is appropriate for brow ptosis not typical upper lid dermatochalasis. Hope that helps.

The upper eyelids, eyebrows and forehead are one continuous unit. If the forehead and eyebrows sag, then the eyelids feel and look heavy. You can prove this to yourself by pushing the forehead and eyebrows downward and seeing what it does to your upper eyelids. The subconscious part of your brain is constantly trying to make it easier for the upper eyelids to function without problem. If your brain detects the excess weight of eyebrows and forehead on your eyelids, it will stimulate the forehead muscles to lift the forehead and eyebrows upward to relieve this stress. As you age and the forehead and eyebrows sags, the stimulus to lift the forehead results in wrinkling. Early in the wrinkling process, Botox or other neuromodulators will relax the muscles and soften the forehead wrinkles. The converse of relaxing these muscles is the eyebrows will sag somewhat and the upper eyelids will look and feel heavy. As the true, natural sag of the forehead and brows becomes worse, Botox treatments become less effective and the eyelids become heavier. If you are at that point, then forehead lifting is your only choice. A good way to determine how much compensation your forehead is doing to correct for forehead sagging is to stand in front of a mirror and close your eyes. With your eyes closed, the forehead muscles relax. Place your finger on one eyebrow and hold it in place, then open your eyes. Opening your eyes will cause the eyebrows to elevate to the compensated position. Release the finger and watch how high your eyebrow lifts. This difference between the fixed and released eyebrow is the amount of compensation you need to correct for with a forehead or brow lift.If you have come to the conclusion that a brow lift is in your future, then you need to consider;the height of your forehead. Most brow lift procedures will raise your hairline. If you already have a high hairline you can have a lateral brow lift, pre-trichial brow lift or direct brow excision - all of these techniques will NOT raise your hairline.If you have thinning hair at the frontal hairline, you may avoid the coronal brow lift (most effective) and consider an endoscopic brow lift.If you only need to lift the outer third of your eyebrows then a lateral brow lift is all that is needed.Types of Brow LiftsCoronal Brow lift - most effective, raises the entire forehead, elongates the forehead, can leave numbness and a scar. May contribute to some hair loss.Endoscopic Brow Lift - does many of the same things as a coronal brow lift, but less effective. scars anr less but the elongation of the forehead persists.Pre-Trichial Brow lift - very effective lifting of forehead and brows without elevating the hairline by placing the incision at the hairline. The scar may be obvious.Lateral Brow lift - will lift the lateral third of the eyebrow without elevating the hairline. Scars are well-tolerated.Direct Eye Brow excision - by removing skin at the top of the eyebrow the eyebrows are lifted but with a scar that may be visible. Simple procedure, quick recovery.If you do not need a brow lift, then the heaviness of your upper eyelids can be treated with a blepharoplasty, which is the direct removal of skin, fat and muscle from the upper eyelid. Most importantly for you is to choose the correct procedure for your problem. After you have decided which procedure is the right choice, find a board certified plastic surgeon to discuss your dry eyes and if there anything that can be done to mitigate your problem.For more information on brow lifts and/or blepharoplasties, please read my book " A More Beautiful You - Reverse aging through skin care, plastic surgery and lifestyle solutions".

If you have dry eyes you want to be very cautious about any peri-orbital surgery.  I would seek the advice of your ophthalmologist prior to considering either procedure.  

For me, the fact that you are already treating dry eyes means that your eye care will remain the same. Of course, you still want to be sure you protect the corneas. A brow lift and a blepharoplasty are not interchangable, That correct different things and have different indications. You need the one that provides the change you desire...or maybe both.

You should cautiously undergo what is the main problem.  Each procedure is for that specific problem.  Dry eyes are very common and when present before any eyelid/brow surgery then one needs to be counseled to have very conservative surgery.  Skin only blepharoplasty helps the eyes still close well vs a skin-muscle flap blepharoplasty.  Punctal plugs or cauterization by an eye doctor can also help with dry eyes.  Besides your Restasis, preservative-free artificial tears will be very important in the early healing period.  If you have laxity of your lower eyelids, then tightening them at the same time can improve your blinking and help with dry eye issues.

Caution is needed because your dry eye symptoms may be worsened temporarily or permanently by upper blepharoplasty; a conservative brow lift might be a better choice since no orbicularis muscle manipulation or incisions are performed, which can slow the blink reflex. In either case, care must be taken to avoid interrupting eyelid closure, especially at night. Discuss this with your opthalmologist before having surgery.

I am sorry to hear about your problem with dry eyes.  It is still possible to have surgery, but it has to be done conservatively. Whether you have a brow lift or a blepharoplasty depends on what the underlying problem is. If the brows are too low, they have to be elevated to a better position.  If the main problem is redundant eyelid skin, then you will need a blepharoplasty. See a plastic surgeon who is versed in all the potential procedures.