Should You Combine a Brow Lift with Blepharoplasty? Expert Insight from Dr. Ali Soueid

Facial ageing is a complex, multifactorial process that affects skin, muscle tone, fat distribution, and bone structure. One of the most noticeable changes occurs in the upper third of the face, where the brows descend, eyelid skin becomes lax, and youthful definition gives way to heaviness and fatigue.

For patients seeking upper eyelid rejuvenation, a standalone blepharoplasty may not always be sufficient. In many cases, a combined brow lift and blepharoplasty offers a more comprehensive and natural-looking solution — restoring not just the eyelid contour but also the brow’s youthful position and expression.

This article explores when to combine these procedures, the anatomy involved, and what to expect from a dual approach.

How the Brow and Eyelid Age Together

The ageing process affects the periorbital region in tandem:

• Brow descent (brow ptosis) occurs due to weakening of the frontalis and loss of forehead skin elasticity.
• The levator aponeurosis of the upper eyelid may weaken, exacerbating eyelid droop (ptosis).
• Excess upper eyelid skin (dermatochalasis) becomes more pronounced as the brow drops lower.
• The result is a tired, heavy or even angry appearance — sometimes severe enough to obstruct vision.

Many patients are unaware that the heaviness they attribute to the eyelids is actually due to brow descent. Lifting the eyelids alone, without correcting the brow position, can sometimes lead to unnatural results or inadequate improvement.

When Is a Combined Brow Lift and Blepharoplasty Indicated?

A dual approach is most effective when both brow descent and eyelid skin excess are contributing to the aesthetic or functional issue. Key indicators include:

• A flat or downward sloping brow, especially at the outer third (tail)
• Visible redundancy of upper eyelid skin extending to the lashes
• Compensatory forehead muscle activation — raising the brows to “see better”
• Excess upper eyelid fullness despite manually lifting the brow
• Obstruction of the superior visual field confirmed by visual field testing

In such cases, correcting one structure without addressing the other may lead to limited or short-lived results. For instance, performing an upper blepharoplasty without correcting brow ptosis may result in over-resection of skin — and potential complications such as lagophthalmos or brow asymmetry.

Customising the Surgical Approach

Dr. Ali Soueid employs a tailored, anatomical approach to facial rejuvenation, always prioritising natural results and facial harmony. Surgical planning considers:

Brow Lift Techniques:

• Temporal (Lateral) Brow Lift: Focuses on elevating the outer third of the brow, where descent is often most prominent. Can be performed under local anaesthesia.
• Direct Brow Lift: Involves skin excision just above the brow. Rarely used for cosmetic purposes but appropriate in selected cases, especially in men or patients with deep rhytids.
• Pretrichial (Hairline) Brow Lift: Suitable for patients with high foreheads, allowing brow elevation without increasing forehead height.

Upper Blepharoplasty:

• Precise removal of excess skin and, if needed, fat repositioning or removal from the medial fat pad.
• Preservation of the orbicularis muscle unless hypertrophic.
• Attention to upper lid crease placement, symmetry, and patient ethnicity.

When combined, these procedures are either performed simultaneously or staged depending on patient preference, health status, and anatomical factors.

Benefits of Combining Brow Lift with Blepharoplasty

• More accurate restoration of youthful anatomy – Addresses both horizontal and vertical ageing vectors.
• Prevents over-resection of eyelid skin – Reduces the risk of postoperative complications like lid lag.
• Improved visual field – Especially in functional blepharoplasty cases.
• Harmonised result – A smooth transition from brow to lid for more natural rejuvenation.
• Single recovery – Combining procedures reduces total downtime and exposure to anaesthesia.

Recovery and Downtime

Recovery varies depending on the technique used but generally includes:

• Bruising and swelling for 7–14 days, more pronounced with combined procedures
• Stitches removal at 5–7 days (depending on incision type)
• Return to work and light activity in 10–14 days
• Full results visible by 6–12 weeks, with scars continuing to fade over several months

Patients are advised to avoid strenuous activity, sleep with the head elevated, and follow postoperative instructions closely to optimise healing.

Non-Surgical Alternatives?

Non-surgical options, such as Botox brow lift or upper lid dermal fillers, may temporarily improve brow position or eyelid contour. However, these are best suited for early or mild ageing changes and do not replicate the results of surgical intervention. They may also be used as adjuncts postoperatively to maintain results.

Why Choose a Dual Approach with a Specialist

Combining upper eyelid and brow surgery is technically demanding and requires a surgeon who understands facial dynamics, symmetry, and proportion. Poorly planned combinations can result in:

• Overly surprised or frozen expressions
• Asymmetry between brows or eyelids
• Incomplete correction of visual field obstruction

Dr. Ali Soueid, consultant plastic surgeon, brings UK and international training with a focus on precision aesthetic surgery. His approach integrates technical expertise, anatomical understanding, and an artistic eye, ensuring every procedure is designed to complement the patient’s natural features.

Final Thoughts

Patients seeking eyelid rejuvenation should always have their brow position assessed. In many cases, combining a brow lift with blepharoplasty is the safest and most effective way to achieve a natural, refreshed appearance — both aesthetically and functionally.

To explore your suitability for upper facial rejuvenation in Dubai, Doha, London, or Beirut, visit www.cosmesticaestheticplasticsurgery.com to book a private consultation with Dr. Ali Soueid.