Upper blepharoplasty or brow lift? (Photo)

Question

Recently, especially after botox in my forehead, I have noticed my eyelid skin touches my lash line, I feel like this makes me look tired. Without botox in my forehead my brows are arched, but the area below the brow is starting to sag, along with extra skin. Will a upper eye lift help me? I have read about issues with deep set eyes and I’m pretty sure that’s what I have. What’s the best course of action to look more awake and bright eyed? I was planning on doing the upper blepharoplasty first

Caner Kacmaz, MD · Answer

You are a great candidate for upper blepharoplasty surgery. After the surgery, droopy and hooded eyelids will improve tremendously when the excess skin and fat from your eyelids are removed. Best wishes.

Thomas A. Mustoe, MD, FACS · Answer

Often the very best outcome is from a conservative skin removal from the upper eyelids combined with a temporal browlift.  However, you would see improvement with a. Upper blepharoplasty alone.

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.​

Selcuk Inanli, MD · Answer

Hello! Thank you for your question. As far as I can see from your photo you have extra skin above your eyes this makes your eye area more small. Your eyebrows are upward so brow lift may not be help you to reach your goal. For a more fresh, elegant looking I recommend you upper eyelid blepharoplasty. Best Regards!

Jonathan Kulbersh, MD · Answer

Thank you for submitting your question and photos. Since your eyebrows appear to be well positioned, a brow lift is unlikely the correct course of action. However, upper blepharoplasty can address the hooding concerns you’re referring to and create a more awake and refreshed appearance. During this procedure, excess skin is removed and the fat in this area is modified to address laxity above the eye. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to review your Botox injection history and determine the best procedure to help you achieve your aesthetic goals.

Mark McRae, MD · Answer

This may not be a popular answer but it is information that I tell all of my patients. Be careful with botox in your forehead. I am not including the glabella region in that warning. This is the region between your medial third of your brow that almost always benefits from botox. Botox to the mid and lateral frontalis muscles is on the other hand often a problem.The issue is that the frontalis muscle elevates the brow. Paralyze it and your brow will drop. When the brow drops below where it should be, the skin below it also sags. All of a sudden you look more tired, angry, and aged. I can't tell without closely examining your brow position but it appears that your brow skin is still located at or above your supraorbital room. I would hold off on the brow lift for now. A conservative upper blepharoplasty is a reasonable approach. Yes you can consider a brow lift in the future to stabilize the brow from dropping. I would recommend for now that you minimize botox to the mid and lateral aspects of your frontalis muscles.

Michelle Zweifler, MD · Answer

Without botox, the eyebrows may arch because the eyebrow frontalis muscle is trying to lift the extra eyelid skin.  Forehead botox blocks this elevation and can lower the eyebrows and the upper eyelids causing hooding,  Upper blepharoplasty to remove the extra skin should give a more awake and bright eyed look.

A.J. Amadi, MD · Answer

An upper blepharoplasty will probably be best suited for you, in a conservative fashion so as not to hollow your upper lids.
Having said that, the head of your eyebrows (the inner aspect towards the nose) are somewhat low, which can sometimes present an "angry" appearance. If this is something that is bothering you, a brow lift focusing mostly on raising the inner aspect of the brows can be helpful, though the results would not be dramatic.  However, it is important that the lateral aspect of your eyebrows are not elevated much as that can create an unnatural "surprised" appearance.
Virtual consultations are available.

William Portuese, MD · Answer

From the photos presented, your eyebrow position is acceptable, so a brow lift would just make you look too surprised permanently. You also have more hooded skin on your right eyelid, and during the  upper blepharoplasty procedure a differential amount of skin is removed to make them look more symmetrical. In our practice, we perform upper blepharoplasty  under local anesthesia which takes about 30 minutes in our surgery center.

Kenneth R. Francis, MD, FACS · Answer

Dear age in reverse,
Botox in the forehead can indeed cause brow ptosis.  Simple solution...stop the botox in the forehead.  Have a frank conversation with your Botox, Jeuveau, Dysport, Xeomin provider so they can tailor your treatments a little better.  Good luck!

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