Upper Blepharoplasty After Botox?

Dear Apple123,
Ideally, you would allow the Botoxto completely wear off prior to eyelid surgery to have the most accurate pre-operative assessment. The Botoxwill have an effect on the position of the brow and how much skin hangs into the eyelid. The most important issue is of course, how exactly was the Botoxdone?
Having said that, the very last millimeter of skin should not be removed from the upper eyelid during the blepharoplasty. An upper eyelid fold should be preserved to avoid post-operative lagophthalmos, which is when the eye cannot fully close.
The amount of skin hanging into the upper eyelid space can have a profound effect on the position of the eyebrow. When the skin of the upper eyelid fold rest on the upper eyelid lashes or eyelid platform, a signal is sent to the brain to elevate the forehead. This forehead activity in the frontalis muscle elevates the eyebrows and lifts the upper eyelid fold. When skin is removed from the upper eyelid, the amount of work performed by the forehead will be incrementally decrease. As the forehead relaxes, the brow falls, and so does the upper eyelid fold. A Botoxtreatment can make this situation better or worse.
If the surgeon doing the surgery also did the Botoxtreatment, presumably they know the effect of their own treatment. However, if they did not perform the treatment, it would be prudent to allow the Botoxto wear off.

I respectfully disagree with my colleagues. Most patients that have blepharoplasty continue their Botox treatments afterwards. I feel that the modern principles related to upper blepharoplasty actually involves SOOF volume replacement along with skin rejuvenation and - if necessary - conservative skin removal.
The older tenants of maximal skin removal with aggressive middle and medial fat compartment resection, in my opinion, leave an unnatural look. After Botox, healing of the eyelid skin is better and a relaxed obicularis muscle encourages more conservative skin removal. I also recommend that you seek consultation with a board certified plastic surgeon.