One of the commonest misunderstandings patients have is the difference between upper blepharoplasty (eyelid re-shaping) and eyebrow lifting. If you and your surgeon do not clarify your goals and understand clearly what each procedure does, you may be disappointed with your treatment results.

With aging, the bony orbit around the eye actually enlarges due to bone resorption. Combined with the loss of fatty soft tissue volume in the brow and more lax skin, there is an appearance of eyebrow ptosis or drooping. In addition, there is frequently a loss of fat in the upper eyelid crease, or fat protrusion through the weak tissue causing a puffiness. You also blink about 10,000 times a day, so usually there is significant lax and droopy upper eyelid skin creating “hooding.”

In general, these characteristics can be improved to create an alert, refreshed and youthful appearance through both surgical and non-surgical means.

Non-surgically, myomodulators or neuromodulators (e.g. BOTOX Cosmetic® injections) can be used to raise the lateral brow, and fillers such as hyaluronic acid (e.g. Juvéderm® treatments) can be used to augment the lateral brow and/or upper eyelid sulcus. These are temporary, lasting about 3 months and 12 – 18 months, respectively.

Surgically, the eyebrow can be lifted to a more youthful position and stabilized in this position. Most commonly today this is done by way of an endoscopic forehead lift or trichophytic forehead left, but there are also other more specific procedures better for certain types of issues. These procedures “open” the eye and, especially, improve the droopy lateral eyebrow.

But the eyebrow lift or forehead lift does not remove excess upper eyelid skin or fat puffiness and protrusion. For this an upper blepharoplasty or eyelid lift (a common term, although actually the eyelid is not being lifted – really excess skin and fat are being excised) is required. However, the blepharoplasty alone does not elevate the lateral eyebrow and any sagging that can occur there.

Some patients prefer the look of the eyebrow or forehead lift, others the eyelid lift, and yet others benefit most from both together. By clearly discussing your goals with your surgeon and doing an analysis together in the mirror, you will be able to select the procedure or procedures that will provide you the most satisfaction. The goal, as always, is a refreshed, less tired, less sad and less aged appearance, one that makes you look the way you feel. And, of course, natural.