Sagging Upper Eyelids: Do I Need a Browlift Too?

Most individuals are best served by eyelid surgery (blepharoplasty) alone to restore a youthful appearance to the upper eyelids. Browlifts add a layer of complexity to the process, as well as increased operating time and cost. However, browlifts significantly improve results when used in the right situations. Also, the recovery time is about the same as with a blepharoplasty alone. Modern methods require only a few small scalp incisions. This reduces the scope of the procedure compared to older techniques and minimizes the risk of hair loss, which is an important concern for many patients.

When is a browlift unnecessary?

Low eyebrow position by itself is neither abnormal nor a sign of aging. Many individuals have them from an early age and it is part of their facial character. Therefore low eyebrow position by itself is not a sufficient reason for a browlift. Experienced surgeons appreciate this and realize that having the tools to raise the eyebrows does not justify a knee-jerk reaction to do so.

So who really needs a browlift?

The best candidates for a browlift are older individuals with both upper eyelid hooding and drooping eyebrows. One of the effects of sagging eyebrows and adjacent forehead tissues and is that it obscures the underlying bony shape of the upper orbit. Blepharoplasty alone is not sufficient in these individuals to both restore a crisp appearance to the upper eyelids and reveal the smooth orbital contour that is also a hallmark of eye beauty. Adding a browlift in these situations will accomplish both goals while also permitting less aggressive eyelid skin removal and a shorter upper eyelid incision. A combined procedure like this produces a pleasing and natural result (Figure 1).

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FIGURE 1. DROOPING EYEBROWS AND FOREHEAD TISSUE OBSCURES THE SHAPE
OF THE OUTER ORBIT AND ADDS TO THE PERCEPTION OF EXCESSIVE UPPER
EYELID SKIN (LEFT). A COMBINED BROWLIFT AND UPPER BLEPHAROPLASTY
EFFECTIVELY RAISES THE EYEBROW POSITION, REVEALS THE SMOOTH
SHAPE OF THE ORBIT, AND REJUVENATES THE EYELID APPEARANCE (RIGHT).

What about browlifts in men?

Men typically have lower eyebrows than women. Browlifts can look feminizing or odd in men. As a rule they are not recommended. Even very low eyebrows associated with hooded upper eyelids are best treated with blepharoplasty alone in men. However in extreme cases it is possible to do a conservative lift of the eyebrows called a browpexy. This is done through the blepharoplasty incision and is much less involved than a browlift.

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