Upper Blepharoplasty After Botox Brow Lifts?

Hi! I am 31 year old female and my upper eyelids have been getting lower. I could see the eyelids in pictures taken about 7 years ago but not anymore. I have been getting Botox for about 3 years now and don't know if this has weakened my forehead muscle causing them to droop more or if it is just my genetics.

My Dr who does my Botox is one of the best around but my brows only responded to a Botox brow lift slightly. Should I go for a tissue sparring upper Blepharoplasty (just skin no fat or muscle)?

Doctor Answers 9

Let Botox Wear Off Before Blepharoplasty or Brow Lift

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If you have had Botox to reduce transverse Forehead Lines your brow may be artificially low as a result. This can cause secondary drop of the upper eyelids.

Wait 6 months for the Botox to wear off and be re evaluated before considering any Brow Lift or Blephaoplasty Surgery. You need an accurate evaluation of your Brow and Eyelids before considering any type of surgery.

Be careful with blepharoplasty without brow support such as lateral hood lift

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With your concerns I would definitely recommend some sort of lateral brow suspension to avoid worsening brow ptosis.  My prefered technique is the lateral hood lift which also cleans up the bulky skin to the side of your eye.  Wiht this technique you will need a much more conservative upper blepharoplasty.  I hope this helps!


All the best!


Rian A. Maercks M.D.

Upper blepharoplasty

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1)  You will do well with an upper blepharoplasty.  But you have a lot of hooding, and some muscle needs to be removed as well as skin.

2)  You do not need a brow lift.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Upper Bleph - best to do when Botox wears off

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It is hard to evaluate your photo as I assume your last Botox injection is still acting upon your brow. I would recommend letting the effects of your Botox fade to normal appearance then seeing a board certifed plastic surgeon. The general trend is to remove less fat than the past for a useful appearance. Skin of course would be removed.

Upper Bleph After Botox?

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The simple answer is that you can have an upper Blepharoplasty after Botox.  However, as others have noted, allowing the Botox to completely wear off prior to deciding on treatment is paramount.  The benefit of omitting or utilizing a brow lift technique is best determined with your brows in their native position.  Muscle sparing Blepharoplasty is the technique I use 90% of the time in my practice to allow for preservation of infrabrow fullness. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Yes, you can have a blepharoplasty after Botox

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The effects of Botox typically last 2-3 months for the initial treatment, and may last up to 6 months or so after 3 years of consistent treatment.  You should wait at least 4-6 months after your last Botox treatment before you consult with a plastic surgeon who can help you to decide whether upper eyelid surgery is right for you..  While the Botox could always have a role, I suspect your issues do have a genetic component.  It does seem in looking at your photo, that you could benefit from upper eyelid surgery.  However, that determination would need to be made in person. Your surgeon would be best able to determine whether fat and/or some muscle should be removed at that same time.  Best wishes.

Michael Vincent, MD, FACS

Michael Vincent, MD
Rockville Plastic Surgeon

Upper blepharoplasty creates deeper fold on eyelid compared to tissue sparing blepharoplasty

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The Botox can certainly weaken muscle if it has been consistently performed over the last three years. This combined with the aging process will have brows descend downward, giving the eyelids the appearance of being saggy. A skin-only blepharoplasty would be an acceptable alternative for your upper lids based on the picture that was presented. It all depends on how deep of an upper lid crease you would like to have. Removing fat and muscle tends to deepen the fold on the upper lid.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

You might look better letting your Botox wear off

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Dear Samnic1

In your photo, your forehead appears over BOTOX'd. There are no lines and yet your upper eyelid folds hang into the eyelid space. A true forehead lift with BOTOX is possible (look at lidlift.com microdroplet BOTOX) but one really needs to understand anatomy to get this effect.

On the other hand, upper blepharoplasty will be a disaster for you. The issue is that you already hold your eyebrow so low (as noted, this may be an over BOTOX issue). When the eyelid fold skin is removed, you incentive to hold the eyebrow where you do will be even further reduced. Your eyebrow will fall further and it will look like the eyebrows are sewn to the eyelashes. This is bad aesthetically because we want big eyes and we don't want the eyes buried under the eyebrow.

I think you might consider an endoscopic forehead lift. This will lift the eyebrows, open the eyes and help make the eye space less crowded--a good thing.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox Browlift can only do so much

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Botox can provide a nice, non-surgical, elevation to the brows. However, this treatment can only do so much. For those who have too much excess skin, Botox may not be enough. In my experience, patient who have skin resting on their eyelashes may require a more aggressive treatment -- an upper lid blepharoplasty.

Jonathan Sonne, MD
Naples Facial Plastic Surgeon

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.