The upper third of the face is often the first region to display visible signs of ageing. Patients frequently present with concerns about a tired or heavy appearance around the eyes, yet the underlying cause can originate from two distinct anatomical areas: the eyebrows or the eyelids themselves. Determining whether the primary issue stems from brow descent, excess eyelid tissue, or a combination of both is essential for selecting the appropriate surgical approach.
Brow lift and blepharoplasty are two separate procedures that address different structures. While both aim to improve the appearance of the upper face, they target distinct concerns and involve different surgical techniques. This guide by Dr Scott J Turner, Specialist Plastic Surgeon (FRACS) practising in Sydney, explains the key differences to help you understand which procedure—or combination—may be relevant to your situation.
Table of contents
How Ageing Affects the Upper Face
Understanding the anatomy of the upper face clarifies why two different procedures exist for what may appear to be a single concern.
The Forehead and Brow Complex
The eyebrows are supported by the frontalis muscle and anchored by fibrous attachments to the underlying bone. Over time, these structures weaken and stretch under the influence of gravity. The result is descent of the brow tissue, which can create:
- A heavy or tired appearance
- Horizontal forehead creases from chronic muscle compensation
- Vertical lines between the eyebrows (frown lines)
- Apparent excess tissue in the upper eyelid area
Importantly, when the brow descends, it pushes tissue downward onto the upper eyelid. This can mimic or worsen eyelid hooding, even when the eyelid itself has minimal excess skin.
The Eyelid Structures
The upper eyelid consists of thin skin, a small amount of muscle, and fat pads. Age-related changes include:
- Loss of skin elasticity leading to excess skin
- Stretching of the muscle layer
- Bulging or descent of fat pads
- Weakening of the muscle attachments that lift the eyelid
These changes occur independently of brow position, though both conditions frequently present together.
What is Brow Lift Surgery?
A brow lift, also termed forehead lift or browplasty, is a surgical procedure that repositions descended brow tissue to a higher position. The surgery addresses the forehead and brow complex rather than the eyelids.
The central goal is elevating eyebrows that have descended below their correct position. In women, the outer brow should sit approximately 1–2cm above the bony rim of the eye socket; in men, the brow typically rests at or slightly above this level. By addressing underlying muscle activity and tissue laxity, brow lift surgery can also reduce horizontal forehead creases and vertical frown lines.
Dr Turner selects the appropriate technique based on individual anatomy, degree of descent, and hairline position. Options include endoscopic brow lift (small incisions within the hairline with camera-assisted visualisation), temporal brow lift (focusing on the outer brow through incisions at the temples), and trichophytic brow lift (incision at the front hairline for patients with high foreheads).
What is Blepharoplasty?
Blepharoplasty, or eyelid surgery, directly addresses excess tissue within the eyelid structures themselves. The procedure can involve the upper eyelids, lower eyelids, or both.
Upper blepharoplasty removes redundant skin and, when indicated, repositions or reduces excess fat from the upper eyelids. The incision is placed within the natural eyelid crease, resulting in a well-concealed scar once healed. Indications include excess upper eyelid skin creating a hooded appearance, fatty deposits causing puffiness, and functional vision impairment from severe skin excess.
Lower blepharoplasty addresses concerns beneath the eyes, including prominent fat pads (under-eye bags) and excess skin laxity. Surgical approaches include the transcutaneous approach (incision just below the lash line) and the transconjunctival approach (incision inside the lower eyelid, avoiding any external scar).
Key Anatomical Differences
The fundamental distinction between these procedures lies in which structure is causing the visible concern. Brow lift surgery targets the forehead, brow, and surrounding tissues to address descended brow position, along with associated concerns such as forehead wrinkles and frown lines. Incisions are typically placed within the hairline or scalp. Blepharoplasty, in contrast, directly addresses the eyelid skin, muscle, and fat to correct excess eyelid tissue, under-eye bags, and eyelid hooding, with incisions placed within the eyelid crease or inside the eyelid itself.
A descended brow can create apparent eyelid fullness by pushing tissue onto the upper lid. In such cases, performing blepharoplasty alone may provide incomplete correction or, worse, create an appearance of brow heaviness by removing compensating eyelid tissue.
Self-Assessment: Determining Your Primary Concern
Before consultation, a simple self-examination can help identify whether your concerns originate from the brow, the eyelids, or both.
The Brow Elevation Test
Stand in front of a mirror with your face relaxed. Using your fingertips, gently lift the outer portion of your eyebrows upward (without pulling the skin horizontally).
Observe the upper eyelid area:
- If the hooding resolves or significantly improves: Brow descent is likely the primary contributor. Brow lift surgery may address your concerns.
- If the hooding remains unchanged: Excess eyelid skin is the main issue. Upper blepharoplasty would be the relevant procedure.
- If there is partial improvement: Both conditions are present, and combined surgery may provide more complete correction.
Brow Position Assessment
Locate the bony ridge above your eye socket. Note where your eyebrow sits in relation to this landmark:
- Women: The brow arch should ideally sit 1–2cm above this ridge
- Men: The brow typically rests at or just above the ridge
If your brow sits at or below this ridge, brow descent may be contributing to your upper facial concerns.
Important: These assessments provide preliminary information only. A thorough clinical examination is necessary for accurate diagnosis and appropriate surgical planning.
When Combined Surgery May Be Appropriate
Many patients presenting with upper facial concerns have changes in both the brow and eyelid regions. In these cases, addressing only one structure may provide incomplete correction or create imbalance.
Rationale for Combined Procedures
Comprehensive Correction: When both brow descent and excess eyelid skin are present, performing both procedures achieves more complete improvement than either surgery alone.
Single Recovery Period: Combining procedures means undergoing anaesthesia and recovery once rather than staging separate operations.
Balanced Results: Addressing the eyelids without correcting a descended brow can make the brow appear heavier. Conversely, lifting a descended brow may reduce—but not eliminate—true eyelid skin excess.
Surgical Planning Considerations
When combined surgery is planned, the sequence and extent of each procedure requires careful consideration. The brow lift is typically performed first, as elevating the brow changes the dynamics of the upper eyelid. The amount of skin removed during blepharoplasty is then adjusted based on the new brow position.
This content is suitable for an 18+ audience only.
Individual results vary depending on factors including genetics, age, skin quality, and lifestyle. All surgical procedures carry risks and require a recovery period. This information is general in nature and does not constitute medical advice or establish a doctor-patient relationship. Patients should obtain multiple opinions and carefully consider the benefits and risks before proceeding with any cosmetic surgery.
