Is brow lift required with upper blepharoplasty? (Photo)

Question

I am looking to get surgery for my drooping eyelids, but in the couple of consultations I've had, they've suggested also having a direct brow lift. I'm worried about the scars from a direct browlift, because although I've seen some good results with barely noticeable scars after a month, I've also seen many examples where the scar is very visible for 12 months, or even permanently. Is the brow lift really necessary?

Gary M. Horndeski, MD · Answer

Routinely, brow lifts are not required with an upper blepharoplasty, but in your case I would recommend it. I would not recommend a direct incision. The incision can be done at the hairline junction. This will pull up the eye brows and decrease the vertical height of the forehead. This will also change the amount of skin needed to be removed at the time of upper blepharoplasty.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Lucian Ion, FRCS · Answer

Thank you for your question and for sharing your photograph. Although an endoscopic brow lift is considered more challenging in men, it can achieve a natural brow repositioning—provided your hairline is still well maintained. The direct excision brow lift is indeed an alternative, but it is not the only option available.

Alternatively, the gliding brow lift can be performed even when the hairline is receding and offers brow elevation that compensates for a low brow position and its impact on the upper eyelid.

Finally, upper eyelid blepharoplasty on its own represents an option; however, even with reduced skin excess, you might still experience a degree of heaviness around the eyes.

John Michael Thomassen, MD · Answer

I would recommend sticking to the upper lid blepharoplasty only.  The direct brow lift leaves an unsightly scar.  I have seen scars that have had months to resolve and are still visible.

Kyle Kimura, MD · Answer

This is a great question! It is always very important to assess the position of the brow when considering blepharoplasty as this is an often overlooked cause for fullness/heaviness/excess skin of the upper eyelids. This is best determined by your surgeon during consultation by evaluating how the brows are contributing to the eyelid issues. While it is hard to determine without being able to evaluate in person, it does look like your brows are contributing and the best results would be from targeting both the eyelids (blepharoplasty) and the brows (brow lift). 
To answer the second part of your question: I often do not recommend a direct brow lift unless you have very heavy wrinkles of the forehead to hide the scar. In your situation, an endoscopic or temporal browlift with incisions hidden in the hairline may be more ideal. 
Hope this helps! Kyle Kimura, MD

Michelle Zweifler, MD · Answer

With an upper eyelid blepharoplasty, the extra skin is excised with the scar in the eyelid crease.  At times, the excess upper eyelid hooding is in part related to eyebrow ptosis/ descent.  A brow lift goal is to elevate the eyebrows, incisions can be placed in the scalp, along the forehead hairline, in a deep forehead crease or along the upper eyebrow.  Scars are permanent and may take a year to mature and fade.

Jeffrey H. Spiegel, MD · Answer

For men, no.  A browlift is not crtical. You could get a conservative blepharoplasty and see an improvement.

Thomas A. Mustoe, MD, FACS · Answer

No.  You do have a low brow and the sole lateral hooding so an upper blepharoplasty by itself Woukd give a modest result, but one that Would look totally natural. A direct browlift is effective in raising the brow but the scar will never be completely invisible and doesn’t look natural. A temporal browlift gives a hidden scar and combined with a blepharoplasty is a highly successful and natural appearing procedure.  It does require more technical expertise.

Zoran Potparic, MD · Answer

Based on this photo it is very likely that both upper blepharoplasty and conservative brow lift will be needed. Depending of the height of your forehead and hairline distance to brows, an endoscopic brow lift with incisions placed entirely on the hair bearing scalp may be considered. Good luck.

John Davison, MBChB, MSc, FRCSEd(plast) · Answer

Hello. You do have a heavy low brow position like men often do.
Open brow lifts are not performed very often - because of the scarring. Easy answer!
You have sufficient upper eyelid skin to have an upper blepharoplasty and it will produce a nice improvement. Obviously it will not change your brow position. You'd probably be happy with that. You may always wish that more could be taken - particularly on the outer area, but further skin removal will just pull your eyebrow down.

William Portuese, MD · Answer

A brow lift does not require required with upper eyelid surgery. You do have low set eyebrows, that's the reason that the procedure was recommended for you. You could just perform your eyelids first, if that makes you happy, great you're all done. You could also undergo a brow lift and your upper lid simultaneously. Regarding brow lifts, there's many different styles and types of that procedure, so a full set of facial and forehead photographs are going to be required to make a determination about placement of the incisions.