The relative contribution of a low-positioned brow and excess upper eyelid skin are very important to ascertain when assessing the appearance of the upper eyelid. A high brow can make the upper eyelid look tight even if there is excess skin and a low brow can make a normal upper eyelid appear to have a redundancy of skin that it does not have.

Generally, if someone closes their eyes and relaxes, and the brow is still above the eye socket, then the brow probably is not low. But if the brow is below the rim of the eye socket, if the brow is flattened without a slight arch with the outer eyebrow a bit elevated, and if there appears to be excess upper eyelid skin beyond the corner of the eye going out into the crow’s feet area, then a browlift likely needs to be considered.

A browlift is a slightly larger procedure than an eyelift, so many people would rather do just the upper lid if given the choice. The important issue to keep in mind if going this route is to not try to compensate for the low brow by removing more than just the redundant upper lid skin. To do so can render a future browlift impossible by overly reducing the upper eyelid skin such that a future lift would threaten if not outright prohibit the eyes from closing. Also, if the distance between the lashes and the brow is too short then it simply does not look attractive.

Another benefit of upper eyelid surgery is that some people with extra eyelid skin reflexively raise their brows to keep the skin from touching their eyelashes. This raising of the brow results in horizontal lines on the forehead. So on occasion an upper eyelid lift can make a profound improvement in the forehead as well.

The key with a browlift is not to raise the brows too much. Even a subtle raise of the brows makes a nice improvement. Dr. Teitelbaum often says, "Brows do drop as we age, but less than most plastic surgeons lift them." Everyone is worried about an upper blepharoplasty causing the "deer in headlights" look. But an eyelid lift does not do that; only an overly aggressive browlift does that. With Dr. Teitelbaum’s excellent judgment, aesthetics, and technique, no patient of his should be concerned with that result.

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