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

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

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.

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