Do I need upper Bleph or Brow lift? (photo)

This is a great question and thank you for the photos!
Unfortunately it is hard to tell definitively without an in person exam. Particularly because it is important to see how much of the upper eyelid heaviness/excess skin is from the brow at rest vs when raising the eyebrows. You may notice when raising your eyebrows the upper eyelid skin has a better contour than at rest. If this is the case, a brow lift may be beneficial with or possibly without the blepharoplasty.
Hope this helps and best of luck!Kyle Kimura, MD

Although I do not have the benefit of a physical examination, so I can understand where your brow sits in relation to the bony orbit of your eye, it appears that your brow has a good position, and also an excellent shape. Therefore the simplest solution for you to rejuvenate your periocular area, would be to have a skin only upper blepharoplasty, performed under local anesthesia only. This would involve only removal of some skin of your upper eyelid, preserving all of the volume to maintain your rejuvenated look. At some point in the future, if your brow does descend, a brow lift could be performed, which can also be performed under local anesthesia only. Have a detailed consultation with your plastic surgeon about these options.

Thank you for your inquiry! By your photos, it looks like you would be a great candidate for an upper bleph procedure as that procedure will remove excess skin to your your upper eyelids therefore making you look more refreshed and rejuvenate your eyes. I recommend scheduling a consult appointment with a board certified plastic surgeon like myself so we can assess your eyes, listen to your goals, and create a surgical plan that is best for you and your goals!

i would probably do an upper bleph right now if you are tight on budget and can't do both because it's a faster recovery and will address the majority of the issue (not 100%). then, if you can't afford the browlift quite yet, you can supplement with a neurotoxin browlift while you wait/save up money.

Before jumping into expensive, invasive surgeries with their risks and post-treatment downtimes, you may wish to explore the option of a nonsurgical. A couple of microdroplets of Botox injected properly at the tails of the eyebrows has been used for years to achieve a "fox eyelift." If still necessary, a small amount of a medium viscosity HA filler placed appropriately to support the lateral eyebrows can further elevate the tails of the eyebrows to establish the more ideal feminine upward and outward flare of the tails of the eyebrows. In experienced hands, both treatments can be performed in about fifteen to twenty minutes. The results of the Botox treatment generally takes one to seven days to appear. Those of the filler are immediately seen right after treatment. You would be wise to consult an experienced board certified cosmetic dermatology filler expert and best of luck.

Based on your photos, I think that mainly your brow has descended into your eyelid area and is creating that hooded/droopy appearance which a brow lift would address. You might also have some excess eyelid skin that a blepharoplasty might address, but this requires measurements taken at an in person consultation. I would suggest getting evaluated by an oculoplastic surgeon who had optimal understanding of the eyelid/eyebrow anatomy, and will guide you to choosing the surgery that will give you the best results without wasting your money.