I am confused as to which would be better in my case: a Blepharoplasty, an endoscopic brow lift, or both? (Photos)

I am uncertain as to whether I need just a Blepharoplasty, brow lift, or both. The 1st pic was taken a couple of months ago. The 2nd pic was taken last week after getting eyelash extensions in an attempt to cover my lids. It didn't work. This is genetic, so the 3rd pic is my 73 yr old father. The 4th pic is me 2 years ago to see any changes. I read that just a brow lift can be the solution for the excess eyelid skin problem & the low brow. Idk. Honestly, Im not even sure if my brow is too low.

Doctor Answers 11

A brow lift is all you need

Dear Mary,

Although the consensus seems to be overwhelmingly in favor of upper blepharoplasty (except for Dr. Shah with whom I agree), my instinct is that you'd best be served by a brow lift.  

The indication for an upper blepharoplasty is eyelid "hooding," where the eyelid hangs over the eyelid (such as in your handsome father), while the eyebrows are in an ideal position.  I'll address your eyebrows shortly, but let's first talk about why an upper blepharoplasty alone will make your eyes appear more aged.

We know from multiple studies that a youthful eyebrow/eyelid appearance is defined by fullness in the space between the eyelid and eyebrow. Look at photos of women in their later years (Google search images with keywords "old eyes") and you'll see that their eye sockets are hollow. If you need more convincing then look at photos of Nicole Kidman in her youth - very full brow-eyelid space with none of the upper lids showing. Hollowed eye sockets is a hallmark of an aged appearance. You have beautiful fullness and it would be a shame to reduce this with an upper bleph.  While some may argue that an upper blepharoplasty won't hollow the eye because only skin is removed, then by that argument the purpose of an upper bleph is only to show more of the upper eyelid. My retort?  Nicole Kidman.  Showing more eyelid is not what makes a woman's eyes beautiful (unless there is "hooding" which your father's eyes show, but which you don't have).  Hence, an upper bleph alone is not the right answer.

You're right in that a brow lift will elevate the eyelid skin up (even more reason not to do an upper bleph on top of a brow lift!). However, my inclination towards a brow lift has nothing to do with your eyelids. In fact, I'm more interested in improving your eyebrow position and configuration because they are tilted downward and frame your eyes in such as way as to convey sadness.  What I mean by this is that you have a downward sloping eyebrows where the "tail" of the eyebrow is lower than the inner aspect which, judging by your age, is genetic.  By scientific studies we know that the "aesthetic ideal" for a woman's eyebrows is that they should rest above the eye socket rim, and they should arch gently upward, apex about 2/3 of the way out, and then gently arch downward.  The "tail" ends up being higher, or at least at the same level, as the inner aspect.  You can see this in Nicole Kidman's eyes - considered to be a raving beauty in her day, she has this beautiful eyebrow configuration, full space in the middle space, and NO upper eyelid show.  So, elevating your outer eyebrows will serve to open and brighten your eyes, and eliminate the subtle appearance of sadness.

In looking at your handsome father, I see that your eyebrow position is genetic. Like him, your eyebrows are right over your eye socket rim (put your finger over your eyebrow and you'll feel the edge of your upper socket), and although your hair is partially covering your left eyebrow, I can see that the left is slightly lower than the right.  Asymmetries are the norm in nature, and it should be your surgeon's goal to correct them as it is mine.  Some patients need both brow lift and upper blepharoplasty, but they tend to be much older than you (such as your handsome father) because eyelid hooding and brow descent occur in parallel over time.  

While I love the results that upper blepharoplasty give, a brow lift is the one for you!

All the best in your search!

Dr. Rad

Washington DC Plastic Surgeon
5.0 out of 5 stars 41 reviews

Blepharoplasty with or without brow lift surgery

Based on photographs alone, you may be an upper blepharoplasty candidate. Upper eyelid surgery can be performed in the office via local anesthesia. A brow lift may be considered down the road, but does not appear to be absolutely required at this time. We've discussed brow lift vs. blepharoplasty in a recent blog post, linked below. If you haven't already, speak with a facial plastic surgeon to perform an examination.Best,Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 77 reviews

Brow lift vs blepharoplasty

Thank you for your question, and the progression of photos is very helpful. Judging only from the photos, I would likely start with just the upper blepharoplasty (eyelid lift). I think your brows appear to be in a nice, attractive position. There seems to be a trend away from endoscopic brow lift (although it's certainly still done), and more toward a "temporal brow lift." This procedure involves an incision near the hairline at your temples, and focuses on just the outer (tail) of the eyebrows. It's a nice compliment to blepharoplasty if you need that. Best wishes.

Paul J. Leahy, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 6 reviews

Brow lift vs. Blepharoplasty vs. Both - I am confused as to which would be better in my case: a Blepharoplasty, an endoscopic br

Hello maryhopeski - Thanks for your question. It is a common source of confusion when patients seeking improvement in the upper eyelid area come for consultation. Looking at your photos, there is evidence that your eyebrows are in a low-set position. You can see this very clearly in your father. If your surgeon manually elevates your brows into a more youthful position, and you like the look, a browlift is in order. If any excess upper eyelid skin gets tightened with just this maneuver, then you only need a browlift.  If you still have loose upper eyelid skin, you need a blepharoplasty as well for complete correction.  If the simulated browlift gives you the "deer in the headlights" look then avoid a browlift. Any upper eyelid skin excess would then just need to be treated with a blepharoplasty alone.  If you are bothered by "hooding" in the lateral eye area and feel that your eyebrows dip down on the outsides, only a browlift can improve this.Looking at your photos, I would venture a guess that you would be well served with a combination of endoscopic browlifting and upper eyelid fractional CO2 laser resurfacing for nonsurgical upper eyelid skin tightening. An actualy blepharoplasty may be overkill. I hope this helps. Good luck, Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

Eyelid issues

It looks like a blepharoplasty may be reasonable but an exam in person is essential. A brow lift is a nice procedure for the right patient.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Do I need a blepharoplasty or a brow lift, or both?

This is a question I address every day in my office. From the photos, I agree that you are an excellent candidate for an upper eyelid blepharoplasty. I would not recommend a complete brow lift in your case, but to improve your brow shape and arch, you could utilize a small incision lateral brow lift, or post-operative Botox.

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 11 reviews

Upper Blepharoplasty

You should focus on the upper blepharoplasty procedure. Your brows are in good position and do not need to be lifted.

Brow lift versus upper eyelid surgery

A brow lift procedure is performed for patients who have very low set eyebrows, which is not the case. An upper blepharoplasty procedure is performed when there is excess skin touching the upper eyelashes and patients want to rejuvenate the upper lids. For more information and many examples of both procedures, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews


Thank you for your question.  Based on your photos, your eyebrows appear to be in an appropriate position, and you would benefit from an upper eyelid blepharoplasty.  I would recommend speaking to a board certified plastic surgeon for an in person evaluation.  All the best, 

Keshav Magge, MD
Bethesda Plastic Surgeon
5.0 out of 5 stars 27 reviews

Brow lift, Blepharoplasty or Both?

Hi and thanks for your question and photos.  An upper lid blepharoplasty would do the trick.  Your forehead and brows look perfect.  By doing the upper lids, your eyes would look bigger and  more open and you would look more awake and alert and rested.  This is a very straight forward procedure that I do in my office under local anesthesia very often.  Good luck.

Jonathan Pontell, MD, FACS
Philadelphia Facial Plastic Surgeon
4.8 out of 5 stars 98 reviews

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.