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22 Sep

Brow Lift vs Blepharoplasty: Which Treatment is Best for Droopy Eyelids?

Brow lift and blepharoplasty are commonly requested cosmetic procedures in people over 40 to reverse the ageing changes in and around the eyelids. In this article I’ll discuss the best treatment for droopy eyelids and brow and how it will improve your look.

Facial aging affects the entire face, but nowhere is it more noticeable than in the area around the eyes because that’s where facial ageing starts. The combined effect of bony and soft ageing around the eyelids not only makes us look older, but can change how we are perceived. Excess eyelid skin or a droopy eyelid can make us look tired and less energetic, while brow descent can make us look serious and even angry. Unknown to you, these changes will gradually affect visual fields.

A simple analogy may help you to understand brow lift and upper eyelid blepharoplasty. Think about coming into a room and seeing that the window curtain is hanging to a point that it is draped on the floor. Before you fix the problem, you have to analyse the cause, is the curtain too long (i.e. redundant eyelid skin) or is the curtain rod (i.e. your brow) too low or both? Your options can easily be determined through consultation with an expert plastic surgeon involving an examination and discussion of your specific concerns and goals.

What each treatment improves

Patients with ageing of the brow and eyelid area have several ageing changes going on in the bone, fat and skin simultaneously. With ageing, redundant eyelid skin and prominent fat pads develop in the upper eyelid. As time goes on, the brows start to drop and the eyelid becomes droopy.

A Surgical brow lift stabilises the position of the eyebrow and only indirectly improves the upper eyelid position. Typically a brow lift is done to improve the hooding of the skin that hangs over the outer corners of the upper eyelids or the heavy brows themselves that hang over the bony prominence of the eye socket above the eyelids.

Upper blepharoplasty effectively removes the excess skin that hangs over the eyelid and often encroaches upon the eyelashes. This results in a youthful upper lid with a defined eyelid crease and eye shadow space. Upper blepharoplasty can be combined with Ptosis surgery to correct the droopy eyelid. The resulting effect is powerful.

How to determine which treatment is needed

When you are being evaluated for upper eyelid improvement to correct droopy eyelids, it is imperative that your surgeon makes the correct diagnosis. Excess upper lid skin, or sagging, comes from the eyelid, the brow being too low or both. Most people with sagging eyelids have a combination of droopy brows and excess eyelid skin. The important thing to decide is what will give the best cosmetic outcome. In some cases both procedures may be necessary as they complement each other.

The first thing to consider is the ideal brow position:

  • For a female, normal brow position is roughly one centimetre above the upper bony margin of the eye socket with the peak between the middle and outer third of the eyebrow. 
  • For a male's eyebrow, it’s ideally situated along the upper bony margin of the eye socket.

If the eyebrow is already in this position but there is still excess skin on the upper lid then all that is needed is an upper eyelid blepharoplasty. A fairly simple manual exam can help determine which is the best procedure or combination for you. If you raise your brows with your fingers to a natural level, does this take care of the drooping eyelids? If it does, then a brow lift alone is the answer. If this doesn't completely take care of the issue, then you would need both procedures. If your brow position is good and you have only excess eyelid skin, then an upper eyelid blepharoplasty is the right choice.

If you need additional information to assist you in deciding whether cosmetic surgery is the right option for you, send me a quick email at info@naveensomia.com.au and I will happily assist you.

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Dr Naveen Somia MBBS, PhD, FRACS

Dr. Naveen Somia is a Sydney Plastic Surgeon who listens to his patients, understands their problems and works alongside them to help achieve their aesthetic goals by applying his skills and years of experience in Plastic and Cosmetic Surgery. A published author on Plastic and Cosmetic Surgery, Naveen’s blog is aimed at helping you make the right choices and stay safe in your quest to look your personal best.