Brow Lifts vs. Eyelid Surgery and Other Alternatives

March 15, 2017 7:19 pm Leave your thoughts

In our interaction with patients, we find that many have questions about eyelid surgery vs. brow lifts for droopy eyelids and other concerns. Both eyelid surgery and the brow lift are big-name procedures, but what exactly they do isn’t as clear to the general public. We’d like to clear up some of this confusion.

In this article, we’ll explain what a brow lift is and what kind of patients it’s best for. We’ll talk about what causes the sagging brows and eyelids that patients often seek to treat with brow lifts, and we’ll talk about when eyelid surgery or nonsurgical procedures are a better option.

What is a brow lift?

A brow lift is a facelift for the upper face; it is a surgical procedure which physically raises the forehead and brows. (Note that when we say “brows,” we’re referring not just to the hair above our eyelids, but also the platform of fatty tissue on which they sit. It is important to remember that this tissue exists between our brows and our bone structure.)

Brow lift surgery is accomplished with an incision or incisions above the hairline (which may be minimized for some patients by use of a surgical instrument called an endoscope) and surgical manipulation of the muscle, tissue, and skin of the forehead and brows.

Who should get a brow lift?

Many patients seek out a brow lift to treat hooded eyelids (i.e. drooping eyelids) or drooping brows. The tissues of the eyelids and brows are closely connected, so drooping of the brows often causes apparent drooping of the eyelids.

Patients with sagging eyelids and/or brows typically have one or more of the following issues:

  1. They were born with low, drooping brows.
  2. Their brows have drooped slightly with age.
  3. They have extra skin and/or fat in their upper eyelids.
  4. They have ptosis, a condition that prevents the eyelid from opening as wide as it should.

All four of these issues can produce the appearance of drooping eyelids, but we’ll focus on the first three. These three issues can all become slightly worse as we age, because the fatty tissue under our brows shrinks, or deflates, as we get older. To picture the effect this can have, imagine your brows as small, inflated balloons stretched horizontally over your eyes. If you let some air out of those balloons, they would no longer be as taut and smooth; instead, they would start to droop from their original positions. This is essentially what happens to the tissue in our brows as we age. However, we have to reiterate that this process is very slight. When we teach other doctors about this topic, we often show these pictures of ourselves to illustrate just how little most brows droop over time:

Dr. Cohen experienced little to no brow drooping from childhood

Dr. Swartz's brows drooped slightly or not at all over time

Now, back to the first three issues we described above, which get slightly worse with age. Different doctors treat these issues in different ways, but more and more frequently, brow lifts are only used for the first issue– brows that have always been low. Why? Over time, doctors’ tools and preferences have changed. Now, doctors often prefer to use non-surgical procedures or eyelid surgery to correct extra skin, because they feel that more natural-looking results can be achieved with less invasive procedures. This is the case at our practice.

What are the alternatives to a brow lift?

At our practice, patients can fix sagging eyelids and/or droopy brows with a range of procedures.

If your brows have begun to droop with age (#2 above), dermal fillers and/or Botox may provide a solution. These are both non-invasive procedures that involve little to no downtime. Here’s how they work:

  1. Dermal fillers can help fix sagging upper eyelids by restoring lost volume to the brows. This gives them the natural fullness they once had, which then lifts the eyelids slightly and makes them look more like they did when you were younger.
  2. Botox can help fix sagging upper eyelids by relaxing the muscles that pull down on your brows when your face is at rest. That’s right- there are muscles “pulling” down on your brows as well as muscles holding them up. Over time, the bottom muscles can overpower the top muscles, pulling your brows and eyelids down to a sagging position. However, once Botox is administered, your brows are free to rise slightly to a more aesthetically-pleasing position, lifting your sagging eyelid skin up with them.

For patients with extra skin and/or fat in their upper eyelids (#3 above), we usually suggest upper eyelid surgery. In this surgery, we remove or reposition tissue in the sagging eyelids to give them smooth, more youthful contours. This results in a more refreshed, attractive appearance for the patient without the need to move the brows from the position at which they’ve always rested. As a result, we believe patients are less likely to look “like they’ve had work done” when they receive eyelid surgery instead of a brow lift, and for this reason, we recommend eyelid surgery to those patients for whom it is a viable option.
The amount of time it takes to recover from eyelid surgeries and brow lifts depends on the individuals and the methods used, but in general, the two procedures have comparable recovery times. To learn more about upper eyelid surgery, including typical recovery times and costs, visit our upper eyelid surgery page.

The Bottom Line

When facing sagging brows and eyelids, many patients wonder whether they should get a brow lift, eyelid surgery, or a different procedure. While the brow lift can be a great option for patients with naturally-low brows, we believe that dermal fillers, Botox, and/or eyelid surgery are a better course of treatment for most patients. These treatments can fix sagging in this area while keeping the brows as close as possible to their natural positions.
Although there is no substitute for a consultation with a qualified cosmetic surgeon, we hope this article has helped you think about these procedures and weigh your options!

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