I am confused as to which would be better in my case: a Blepharoplasty, an endoscopic brow lift, or both? (Photos)
Doctor Answers 11
A brow lift is all you need
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!
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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.
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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.