The Surgeon Minute

How to Choose Between Brow Lift and Eyelid Surgery, or Both

How to Choose Between Brow Lift and Eyelid Surgery, or Both

It’s one of the first places to show signs of aging – the upper face. The eye area and the forehead often develop wrinkles and sagging first, which can make you look tired, sad or even angry. Facial rejuvenation can turn back the clock with a brow lift and/or a blepharoplasty (eyelid surgery).


Board certified plastic surgeon Dr. John Q. Cook details how to know which procedure is the right choice for a more youthful appearance.

Which Procedure is the Right Choice

It often starts with what you see when you look in the mirror. Do you see yourself as looking “tired,” “angry,” or “sad,” even though you are happy and joyful? It may be that’s its time to consider facial rejuvenation, especially in the area that is most reflective of youth – the eyes. “As the saying goes ‘the eyes are the mirror to the soul’ and people tend to infer things about you depending on how your eyes look,” shares Dr. Cook. Cook, the founder and medical director of the Whole Beauty Institute in Chicago, Illinois, says aging eyes can make a person appear much older than their years. “Friends may think you look tired or angry or sad and you aren’t feeling that way at all. That’s often what drives a patient to come see us.”

Eyelid surgery and brow lift.

One of the most important first steps in changing the appearance of your upper face is to decide if you want a brow lift or eyelid surgery. Cook indicates that it’s important to pursue the proper treatment not only for a good aesthetic outcome, but for proper function. “A couple of bad things can happen if you try to treat brow descent just with upper eyelid skin,” he explains. “What’s going to happen is you are going to over compensate for it and the three dimensional form isn’t going to flow properly. It’s not going to make sense and in some cases they will have difficulty closing their eyes.”

Brow Lift Surgery

The eyebrows are a critical variable in showing emotion. When the brow falls or is furrowed, it may give the appearance of fear, concern or worry. A brow lift can brighten your entire appearance and change how others see you. In a brow lift, the surgeon will make incisions just above the brow to lift and tighten the skin above your eyes. Dr. Cook uses several different techniques. “There’s a lot of different options for brow position. If there’s just a little decent, sometimes we can solve the problem just using Botox. In a situation where it’s more severe, or the patient doesn’t want Botox, there’s a number of procedures we can do.” He indicates that one procedure doesn’t leave behind scars that are visible. “The endoscopic brow lift has the advantage of tiny incisions just behind the hair line, so there isn’t any kind of lengthy scar that is easy to see.”

Eyelid aging progression.

Another procedure pulls the brow up – the subcutaneous brow lift. “We do this one under local anesthesia,” shares Cook. “We make the incision under the hair line and that’s an effective way of bringing the brow up.”

The proof of success may be in the picture; Cook thinks one of the best indicators of the right course of treatment is to look at old photos. “We like to see old pictures for all of our facial rejuvenation patients because we want to maintain facial identity.”

Eyelid browlift results - Dr. Cook.

What Men Want

The upper eyelid is a worker. It blinks thousands of times per day and all that movement can cause the skin above the eye to become thin and loose. With age and time, the skin can start to sag. It’s the reason why many people seek out upper eyelid surgery. Many of those looking for rejuvenation are men who want to look and feel better, too, according to Cook. “For men, it is often the eyelid, along with the neck and jaw. Women get frustrated when they can’t put on eye shadow anymore.”

Cook says recovery from an eyelid surgery or brow lift is relatively easy and produces remarkable results, most of the time. “If you wear a slightly tinted pair of glasses for a couple of days and stay away from work or social events, most people will not even notice. When a brow lift is done well, you get good stability in the results.” Cook thinks the upper eyelid is worth the minimal pain to achieve a rested look. “I’ve always said, upper eyelid surgery by itself is probably one of the best ratios for patients in plastic surgery, in terms of the benefit you get for the aggravation you have to go through.”

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