Eyelid Surgery vs. Brow Lift: What’s the Difference?

eyelid surgery vs brow lift

Everyone will experience changes in some degree to our skin, bones, and muscles as we age. While natural aging affects the appearance of the entire face, the area around the eyes is often the first facial area to show the signs of aging. One of the most undesirable forms of facial aging is the drooping of the upper eyelid.

This eyelid drooping can be triggered by two specific issues. First, excess loose skin and fat pads develop in the upper eye giving the appearance of being old and tired. Second, the brow can begin to descend, creating further heaviness to the lateral eyelid (called “hooding”). As the descent increases, the eyes may appear to be stuck in a permanent scowl. Drooping can of course be caused by a combination of both issues.

Depending on underlying causes, patients interested in correcting upper eyelid drooping may require upper blepharoplasty (eyelid lift), brow lift (also called “forehead lift”) surgery, or the combination of both procedures. Here’s how to tell which procedure might be most appropriate for you.

Do I need blepharoplasty or brow lift surgery?

One way to explain if upper blepharoplasty or brow lift surgery is necessary is through an analogy. Picture drooping eyes as being akin to someone wearing pants that hang too low to the point where cuffs drag on the floor as they walk. The issue may be due to the pants being too long (i.e. excess skin, loose muscles or excess fat along the eyelid), a loose belt that is not able to keep the pants up (weakening of the brow), or some combination of both issues.

Eyelid Surgery

Upper blepharoplasty will address drooping of the eye that is caused when sagging skin, loose muscle, or excess fat tissue along the upper eye hangs over the eyelid. This form of eyelid surgery targets the upper lids and is ideal to correct fatty or excess skin that can fall over the eye, causing a disruption in the natural contour of the upper eyelid and in severe cases visual impairment. The procedure consists of removal of fat deposits, tightening of muscles and tissue, and/or removal of excess skin through a very fine incision placed in the natural upper eyelid crease.

Brow Lift

Brow lift surgery will address the weakening of the eyebrows caused by slack muscles and connective tissue in the upper face. The procedure stabilizes the position of the eyebrows back to a youthful level which indirectly improves upper eyelid appearance. Specifically, brow lifts can work to tighten the drooping of skin over the outer corners of the upper eyelids. The most common type of brow lift surgery is called “endoscopic brow lifting”. In this procedure, multiple short incisions are made along the scalp behind the hairline. The surgeon then raises the entire forehead off the underlying skull and tightens the loose tissues. Very little skin is excised. Instead the loose skin is lifted with the deeper layers of the forehead and shifted backwards.

How to determine which procedure is needed

The best way to determine which procedure is needed to correct droopy eyelids is through an in-person evaluation by an experienced plastic or facial plastic surgeon. The correct diagnosis of the underlying cause is the only way to ensure good results. Droopiness can be caused by the brow being too low, excess upper lid skin, or a combination of both issues.

Your surgeon will first consider the current state of your eyebrows. For women, the ideal lateral brow is positioned above the upper bony margin of the eye socket. In men, the ideal position is right along the upper bony margin. With this in mind, your surgeon will perform a simple exam to determine three possible outcomes:

1). If your brow is already at or near this ideal position and drooping is occurring, then just upper blepharoplasty may be necessary.

2). If your drooping completely goes away when the surgeon raises your brows to the ideal position then a brow lift may be required.

3). If your drooping improves (but is not adequately corrected) by raising the brow to its ideal position then a combination of brow lift and upper blepharoplasty may be needed.

 


Minas Constantinides, MD, FACS

Dr. Minas Constantinides is a board-certified Facial Plastic Surgeon at Westlake Dermatology & Cosmetic Surgery in Austin, Texas. He is on the Executive Committee of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and is a Senior Advisor of the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).


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