It is possible for a patient to have low brows, redundant excess eyelid skin, or both. Though this question frequently comes up, the reality is that these procedures are distinct entities. But for the patient who wants to do one at a time, it is important to ascertain which one is the biggest contributor to the problem. Many patients prefer to do just one procedure at a time, and there are circumstances where the issues are too subtle to allow simultaneous surgery anyways (it wouldn’t provide the requisite opportunity for precision). The eyelift happens to be an easier recovery and less expensive procedure, and so patients in borderline situations often choose to do the eyelift first. However, ideally, the brow lift would be done first. The reason is that a plastic surgeon can be precise with the amount of skin removed in an eyelift but cannot be as precise about where the brow height will be after the result has settled. So if the brow is done first, then the precise amount of skin can be removed with an upper blepharoplasty to optimize the result but not remove so much skin that the eyes do not close adequately.
Fatty pockets in the upper eyelid can only be corrected with a blepharoplasty, and "hooding" of the upper eyelid area beyond the ends of the eyes invariably needs a brow lift for correction because the blepharoplasty only removes excess eyelid skin and cannot adequately treat the excess beyond the lid.
Dr. Teitelbaum is an expert in evaluating the relative contribution of the brow and eyelid to the appearance of the eye and guides his patients to the procedure that will make their eyes as stunning as possible.
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