When it comes to addressing hooded eyes, the procedures that are usually discussed are an upper lid blepharoplasty or brow lift. These surgeries both work on the upper third of the face, but they’re quite different in their approach.
Both can change the shape and position of tissue around the upper part of the face. Whether one is more suitable than the other really comes down to what’s causing the hooded eyes.
Hooded eyes can be caused by the skin of the upper eyelid folding over due to excess tissue, or it may be due to the brow sitting lower than it used to. Sometimes, both of these factors can be contributing to hooded eyes, which is why it’s not always an obvious decision between the two procedure options.
Let’s go through the main differences between the two procedures, including what they address and how they’re performed. It’s not about whether one is “better,” it’s about understanding how each procedure works and why a surgeon may recommend one over the other – or sometimes even a combination of both.
A blepharoplasty or brow lift for hooded eyes: The differences between the two options
An upper lid blepharoplasty involves removing excess skin, and sometimes a small amount of fat or muscle, from the upper eyelids. A carefully placed incision is needed in the crease of the lid, which allows access to the underlying tissue.
The aim is to reduce the skin that folds down onto the lash line. The amount of skin removed is always measured carefully during surgery, as taking too much can affect eyelid closure.
A brow lift focuses entirely on the position of the eyebrows and the tissue above them. Rather than removing skin from the eyelids, this procedure lifts the forehead or outer brow region, depending on the technique used.
There are a few ways this can be performed, such as a temporal brow lift (which only raises the outer brow), or a full brow lift (which lifts across the entire forehead).
Understanding the cause of upper eyelid hooding
Hooding of the upper eyelids can be caused by a few different anatomical changes. For some patients, the skin on the upper lid starts to fold over the lash line, while for others, the excess skin comes from the brow. When the brow lowers over time, it can push the skin below it downward, causing the upper lid to appear hooded even if there isn’t much excess eyelid skin present.
It’s not unusual for both factors to be involved at once, which is why the decision between the two procedures can sometimes require a more detailed assessment.
During a consultation, a surgeon will often look at where the crease of the upper eyelid sits in relation to the brow, and whether lifting the brow restores a visible lid crease. This can help determine whether a brow lift, blepharoplasty, or both might be appropriate. If the brow position is stable and the hooding is caused mainly by the eyelid skin itself, a blepharoplasty may be sufficient on its own.
What an upper lid blepharoplasty involves
An upper lid blepharoplasty is performed to remove excess skin and sometimes fat from the upper eyelid. The incision is usually made in the natural eyelid crease, which allows access to the tissues. The skin is then placed back carefully after removing the appropriate amount of tissue.
The procedure focuses on the upper eyelid only, which means that if the brow has descended over time and is contributing to the weight on the lid, a blepharoplasty alone may not be sufficient.
Eyelid surgery can be quite precise in terms of how much tissue is removed. The goal is to avoid taking too much skin, as this can lead to difficulty closing the eyes or tightness across the upper lid. The aim is generally to remove just enough excess tissue without interfering with eyelid function.
How a brow lift works to change the upper face
A brow lift shifts the position of the brow and forehead area upwards. There are different techniques that can be used to do this and the choice of technique depends on the specific anatomy and the degree of movement required.
A lateral (temporal) brow lift is often chosen when the outer third of the brow has descended more than the inner part, which is common in many cases.
By lifting the brow, the tissue that sits just above the eyelid is repositioned, which can reduce the amount of weight pushing down on the upper lid. The procedure doesn’t remove eyelid skin – instead, it repositions the brow to where it may have originally sat.
Unlike a blepharoplasty, a brow lift doesn’t usually involve the eyelid crease or the eyelid skin directly. That said, in some cases a brow lift can also reduce mild upper eyelid hooding by lifting the skin away from the lash line, although this depends on how much movement is needed and how much the brow is contributing to the hooded eyes.
When both procedures may be performed together
There are instances where a brow lift alone won’t fully address the heaviness of the upper lid and a blepharoplasty may not be sufficient. In these situations, a combination of both procedures may be considered, which allows the brow to be lifted and supported, while also removing any excess eyelid skin that remains once the brow is in its new position.
Addressing both areas can help ensure that neither surgery compensates incorrectly for the other – for example, preventing too much skin being removed during a blepharoplasty when the brow hasn’t been lifted first.
What to expect during a consultation
During an in-person assessment, the brow position, forehead movement, eyelid skin and eyelid crease depth are all reviewed.
The surgeon may physically lift the brow to demonstrate how the eyelid changes, and this can often make it clearer whether the upper lid issue is being driven by brow descent or excess upper eyelid skin.
Photography is usually part of the assessment process, allowing for a side-by-side comparison of brow position, lid position, and the crease before and after elevation of the brow. These reference points can help guide whether a single procedure or a combination will be required.
In many cases, the decision between upper lid blepharoplasty and brow lift comes down to which tissues are involved and how much support is needed across the upper third of the face.
Our Specialist Plastic Surgeon at Rodin Clinic Perth: Dr Robert Choa
To discuss your upper eyelid surgery or brow lift options, meeting with an experienced surgeon will allow them to assess your individual needs.
Their approach will be based on a physical assessment of your anatomy, and they can advise whether one or both procedures would be appropriate based on what’s actually contributing to your hooded eyes.
To get in touch with our team at Rodin Clinic in Perth, please fill out our online form, email us at reception@rodinclinic.com.au or call us at 08 9389 9522.