Blepharoplasty vs. Brow Lift: Which is Best for Sagging Eyelids?

Home » Blog » 2021 » June

A common concern among our patients is the heaviness of the upper eyelid, which can lend an appearance of drowsiness, chronic fatigue, or aging. Patients who notice their eyelids beginning to droop might assume that they are only experiencing an eyelid problem, but that may or may not be the case. It is important to note the intimate relationship between the eyelid and the eyebrow, and to be aware that this sagginess could be a factor of the eyelid skin, or else it could be related to the positioning of the brow itself.

Before being treated, patients need to be carefully assessed, allowing their Oculofacial Plastic Surgeon to understand the underlying cause of their sagging eyebrows. Based on this assessment, the provider may recommend a blepharoplasty (a surgical procedure that addresses the skin of the eyelid itself) or an eyebrow lift (which addresses the brow).

Dr. Biesman is an oculofacial plastic surgeon with more than 25 years of  experience in assessing patient needs and recommending which of these procedures is best suited to produce the best aesthetic outcome. To find out more about making your eyes look more youthful, rested, and awake through a blepharoplasty or a brow lift, schedule a consultation with Dr. Biesman.


Blepharoplasty vs. Brow Lift: Understanding the Difference

brow lift before and after

Dr. Biesman sees many patients whose primary concern is the heaviness of the upper eyelid. In some cases, it really is just an upper eyelid problem; the eyelids are in perfect position. Keep in mind that the “normal” eyebrow position is different for men and for women. Men tend to have lower, flatter brows while women typically have higher, more arch brows. Of course, this can vary from individual to individual. Preserving your natural look is extremely important to Dr. Biesman. He will often ask you to bring old photographs to your initial consultation so he can assess your face when it was more youthful.

When a brow descends, as it does push skin into the eyelid. In the event that a surgeon was to remove eyebrow skin that had descended into the eyelid, the result can be disastrous.  The eyelid is sewn to the eyebrow and the lids still appear heavy.  When attempts are made to subsequently correct this by elevating the brows, there isn’t enough skin left to allow the eyes to close.  This scenario is better avoided than treated!

All of this is just to say that the relationship between the eyelid and the eyebrow is a delicate one. Because the blepharoplasty deals with the skin of the actual eyelid, while brow lifting addresses eyebrow contour and position of the brow, patients with sagging eyelids need to undergo an evaluation to determine whether they have an eyelid condition or an eyebrow condition, or both. (There is also a third possibility, that the patient has droopy eyelids, a condition known as ptosis, meaning there is an issue with where the position of the upper eyelid rests relative to the pupil.) 

Patients are generally better off getting an eyebrow lift when their droopy eyelid is really a result of the brow descending, pushing skin down toward the eyelid. With that said, there are some patients who have always had heavier brows, and the last thing Dr. Biesman wants to do is to make surgical changes that give them a look they have never had before. As such, part of the assessment process means looking at old photos of the patient, which can provide a good sense of whether the person’s brows have always been higher, lower, or somewhere in between.

Dr. Biesman’s general approach is to preserve a youthful appearance for the eyebrow, which may involve repositioning the outer part of the eyebrow (a lateral brow lift) or a full brow lift. Patients should know that brow lifts are usually made with incisions behind the hairline, one or two on each side. These incisions are made to be well-hidden beneath the hair. The eyebrow is released so that it can be moved up into a higher position, at which point the incision sites are closed up. According to Dr. Biesman, when a brow lift is done well, only a patient’s hairdresser should know they’ve had it done.


Blepharoplasty vs. Brow Lift: Common Questions from Patients

As you seek the best treatment to help your eye look more youthful and fresh, it is only natural to have some questions. Here are answers to some of the most common inquiries.

blepharoplasty before and after


How do I know if I need blepharoplasty?

This is a decision that’s best made together with your oculofacial plastic surgeon, who will assess your facial appearance and give an expert opinion on whether you need a blepharoplasty or a brow lift, or a combination of these procedures will best help you achieve your goals.

Am I too young for a brow lift?

Though not extremely common, Dr. Biesman does sometimes operate on patients who were simply born with heavier lids and wish to have them lifted; this can sometimes be done on patients who are in their twenties.

Will getting a blepharoplasty fix wrinkles around my eyes?

Not much. It can sometimes help a bit with crow’s feet wrinkles, but it is unlikely to make a dramatic difference. Certainly, wrinkle reduction is not a good primary reason to pursue this particular operation.

Will getting a brow lift cause me to look permanently scared or surprised?

Dr. Biesman’s goal is to help you look your best while retaining a natural, rested appearance. He is careful not to over elevate the brow. The “scared” or “surprised” look is going to be most common when lifting the brow of someone whose brow was never very high to begin with. By properly shaping and contouring the brow, Dr. Biesman ensures that patients achieve the results they want without undesired changes to their facial appearance.

Will people still recognize me after I have eyelid surgery?

While there will be a noticeable change in your appearance, it tends to be fairly subtle. Patients typically look refreshed, but the results will not be so dramatic that people will know work has been done.

What’s the recovery like for a blepharoplasty or brow lift?

For either of these surgeries, recovery may take between seven to 10 days. Patients shouldn’t schedule major events for several weeks after surgery. For the most part, though, taking about a week off should be fine. Patients may take some pain medications for a few days, but most say that their discomfort is very minimal.

Schedule a Consultation with Dr. Biesman


To address sagging eyelids or tired appearing eyelids, it is crucial to determine the underlying issue, and from there make a plan for blepharoplasty or a brow lift, ptosis repair, or a combination of these procedures.  Eyelid rejuvenation can be complex and only an experienced surgeon like Dr. Biesman can help you learn which procedures will be best for you. To find out more, schedule a consultation with Dr. Biesman at your next opportunity.

An Oculofacial Plastic Surgeon’s Guide to Injectable Fillers for Facial Shaping and Contouring

Home » Blog » 2021 » June

Many patients are aware of dermal fillers, which can be injected into the skin to produce a “plumping” effect. In recent years, these injectable fillers for facial shaping and contouring have gained considerable popularity as a safe, non-surgical option.

Before getting fillers, it’s helpful to understand that there are many different fillers on the market today, and that each has its own unique characteristics. Crucially, patients shouldn’t “shop around” for the right fillers; instead, the best approach is to meet with a facial rejuvenation expert like Dr. Biesman, who can recommend the specific type of filler that will help produce the intended effect.

As you learn more about injectable fillers, spend some time with this overview from Dr. Biesman.


What are the Different Uses of Injectable Fillers?

According to Dr. Biesman, there are three primary uses for facial fillers, like those that are used for a liquid face lift.

  1. Recontouring the face. Beauty and aesthetics is not just about wrinkles; facial balance and contour is a critically important yet often overlooked aspect.  Soft tissue fillers may be used to optimize contour in a variety of ways including enhancing’s the cheek bones, the chin, jawline, and even the nose, forehead and eyebrows!
  2. Revolumization. Over time, our faces tend to deflate. We lose soft tissue volume in the central part of the face, the eyebrows, the forehead, the soft part of the cheek between the cheek bone and the jaw, the chin, the lips, and the area around the mouth. All of these areas lose volume over time, but fillers can be used to restore volume, and therefore to restore a more natural, youthful appearance.
  3. Treating fine wrinkles and lines. The first two uses of facial fillers represent the overwhelming majority. This third use is much less common, though still important. Facial fillers may be used to reduce the appearance of fine lines. Fine lines are generally more noticeable to patients themselves than to others.  Examples of areas where fillers are commonly used to treat fine lines include the forehead, area around the mouth, the neck, and sometimes the cheeks.

These are the primary uses of injectable fillers in the face, though it’s worth noting that injectable fillers may occasionally be used to restore lost volume elsewhere on the body, most typically the hands.


Which Facial Fillers are Right for You?

As you consider whether injectable fillers might help you achieve your aesthetic goals, it’s important to keep in mind that there are many facial fillers on the market today. All of these facial fillers are slightly different from one another. The best way to determine which specific filler is most aligned with your goals and expectations is to schedule a consultation with Dr. Biesman, who will perform an assessment and then make an expert recommendation.

How exactly do facial fillers differ from one another? Some are quite soft, meaning they integrate beautifully into the skin. These are good options if you’re looking to fill a fine wrinkle or line. In other cases, however, you might need a filler that’s strong, such as when you’re trying to elevate the cheek bones or pick up the face from behind the hairline. These procedures require more structured, stiff fillers.

In addition to the fine fillers and the more robust ones, there are also some fillers that fall somewhere in between. Medium fillers are used very often to treat the area around the mouth, the lips, the under-eye area (tear trough), and others. 

The bottom line: Dr. Biesman uses fillers all over the face, sometimes in conjunction with eyelid surgery or an eyebrow lift, sometimes in conjunction with other injectables, and sometimes in conjunction with laser therapy, also known as laser skin treatments. These procedures complement one another and accomplish different objectives. No matter what you’re trying to accomplish with your fillers, though, the goal is always for the results to look natural. Dr. Biesman and his team do not want you to look as if you have “had work done”; they want you to look rested, fresh, youthful and vibrant.  The results should be subtle, elegant and understated yet at the same time beautiful.

Dr. Biesman considers all of this when determining which filler is best for the patient.

The Process of Getting Injectable Fillers for Facial Shaping and Contouring or the Treatment of Fine Lines.

For those who have never gotten fillers before, it’s natural to have some questions about what the experience is like.

Dr. Biesman and his team emphasize patient comfort, and try to make the filler experience as fun and as enjoyable as possible. This includes ample patient education; when you join Dr. Biesman for fillers, you’ll be given plenty of information about what to expect before, during, and after the procedure, which can help allay any lingering anxieties. Note that Dr. Biesman’s office is available in case of emergency 24/7. Routine questions after hours can be submitted via DM on our Instagram account, @drbiesman

Ultimately, the filler experience is a comfortable one, and most patients are exceedingly happy with their results.


How Long Will My Injectable Fillers Last?

Another common question among patients: How long will injectable fillers last? The short answer: A lot longer than most people tend to think.

A more helpful question might be, how long will the fillers last before they need to be touched up? This all depends on the area treated and the type of filler used. Be aware that there is some variability from one filler to the next with regard to how long they last. On average, patients can get 12 to 18 months before they need to return for a touch-up, though the lips usually require more frequent appointments.


What Should I Expect After My Treatment?

Once you get injectable fillers, you can anticipate there being a little bit of swelling around the treated area. With that said, Dr. Biesman says that any discomfort should be minimal, and shouldn’t create too much disruption to everyday life.

Due to the swelling, it’s recommended that you not have fillers immediately before taking a family photo, going to a wedding, or having a big client meeting. Allow two or three days for the swelling to subside before any such event.

Schedule a Consultation with Dr. Biesman


 Injectable fillers can be highly effective for facial shaping and contouring and natural and effective facial rejuvenation. An important first step is meeting with a skilled specialist who can determine the specific type of fillers you need to achieve your desired results. To schedule an appointment with Dr. Biesman or his extremely capable nurse, Molly Katz, RN, reach out to the office at your convenience.

Considering Facial Fillers or Plastic Surgery?

Home » Blog » 2021 » June

Patient received facial injections in the following areas:
Brows, Cheeks, Tear Troughs, Lips, Nasolabial, Marionette, Prejowl Sulcus

As time passes, our faces begin exhibiting signs of age. The signs of aging can include loose, sagging skin around the cheeks, the chin, or the neck. They can also include a loss of volume, leading to a hollow or sunken appearance. While there’s no way to turn back the hands of time, there are proven, effective solutions to conceal the signs of aging and to regain a firmer, more youthful appearance. Two of the most common solutions are facial fillers and plastic surgery.

As a patient, how can you determine whether facial fillers or plastic surgery is best for achieving your aesthetic goals? One of the most helpful steps you can take is to schedule a consultation with a plastic surgeon, who can recommend a treatment option that will help you achieve your aesthetic goals.

Dr. Biesman is an experienced Oculofacial Plastic Surgeon with expertise rejuvenating the mid- and upper face. While Dr. Biesman does not perform facelift or neck lift procedures, he will advise you if he believes one of both of these procedures is your best option.   Should you wish to pursue a nonsurgical approach, Dr. Biesman will help you determine your options and the risks, benefits, and expectations associated with each. Indeed, Dr. Biesman is a facial rejuvenation expert and talented in using facial fillers to reshape the structure of the face, to provide volume correction, and even to reduce the visibility of wrinkles and fine lines.


Facial Fillers vs Plastic Surgery


To begin with, it is important to understand that both facial fillers and plastic surgery are tools, and they can both be used to advance the same goal of facial rejuvenation, namely, reversing some of the visible signs of age, leading to a brighter and younger facial appearance.

The major distinction between them is in just what kind of results you can expect from either tool. Facial fillers and plastic surgery can both rejuvenate your facial appearance, but the specific outcomes vary considerably.

As such, it is important to seek the expertise of someone like Dr. Biesman, who can let you know whether you are a candidate for surgical or for non-surgical treatments; and, if you qualify for both, to clarify the expectations for either treatment path.


Top 3 Uses of Facial Fillers


As you seek to make a decision between facial fillers or plastic surgery, it may be helpful to understand the three primary uses for facial fillers.


  1. Facial fillers can be used to structurally reshape the face to reduce signs of aging, or to correct issues that arise from genetics.
  2. Fillers can provide volume correction, specifically smoothing out hollow areas under the eye to achieve a more natural transition between the under-eye area and the top of the cheek. They may also be used to add volume to the cheeks, temples, chin, jawline, lips and other areas as part of total facial rejuvenation with facial fillers.
  3. Facial fillers can reduce the appearance of fine lines, especially around the forehead, between the eyebrows, around the mouth, the lips, cheeks and the neck. Note that this is one area where Botox may not be advisable, simply due to the underlying muscle structure.


There are also a few things that dermal fillers can’t do. For example, fillers cannot address issues of skin quality or quantity, which means they may not be sufficient for correcting sagging skin around the mouth. What they can do is create volume and lift, improving the appearance of patients whose overall skin quality is strong. They can also address loss of volume/deflation, which are among the most common signs of aging.

What about wrinkle prevention? While most dermal fillers cannot prevent the development of wrinkles, Botox injections can do this by limiting the movement of muscles that lead to wrinkle formation.


Using Dermal Fillers for Facial Rejuvenation


Dermal fillers are injectables that are used in total facial rejuvenation. They offer an almost instantaneous result, rejuvenating the facial appearance by restoring lost volume in the cheeks, improving contours of the face, and smoothing out wrinkles and creases.

Dr. Biesman has carefully selected a group of dermal fillers to offer patients, and he has demonstrated skill and craft in using them to achieve the optimal results. Note that Dr. Biesman also offers Botox, an injectable that works a bit differently from soft tissue fillers; Botox relaxes muscles and can specifically be used to relax the facial muscles that create crow’s feet, furrowed brows, forehead lines, downturned corners of the mouth, lines in the neck and others.  Botox can even be used to shape the face and improve jawline contour.

Dermal fillers have become popular because they may allow patients to achieve facial rejuvenation without the need for surgical intervention. Keep in mind that the results achieved through fillers are not the same as the results achieved through plastic surgery.


Using Facial Plastic Surgery to Correct Signs of Aging


Facial plastic surgery is a technique typically utilized to accomplish several objectives including “picking up” structures that have fallen, removal of skin, muscle, or fat which may be present in excess quantity, or to rearrange tissues that have shifted. If you need one or more of the above issues corrected, then surgery is the only path because these are not addressed with non-surgical approaches like facial fillers.

Facial Fillers Or Plastic Surgery? Dr. Biesman Can Help Determine Which Is Right for You

Again, it is important to keep in mind that facial fillers and facial plastic surgery are both tools that can be used to achieve the best version of yourself; and though both of these treatments have the same basic goal, they differ in exactly what they can accomplish. For patients, it is crucial to have the right expectations.

A good way to set those expectations, and to choose the treatment best aligned with your cosmetic goals, is to schedule a consultation with Dr. Biesman. A leading name in facial rejuvenation, particularly with dermal fillers, Dr. Biesman can help you find the treatment plan that best meets your facial rejuvenation needs.

To learn more about the benefits of facial fillers vs plastic surgery, schedule a consultation with Dr. Biesman in Nashville, TN.