The best way to get this question answered is to have an evaluation by a plastic surgeon that is certified by the American Board of Plastic Surgery and is experienced is both eyelid and brow lift procedures.
Like the name of the procedure implies, a brow lift raises the position of the eyebrows. In addition, during a brow lift procedure, the muscles that pull the brows inward and downward are partially removed so that the brow furrows are lessened or eliminated when you try to frown. In general, some muscle remains so that there is still some natural brow motion to avoid a mask-like effect. My preference for the brow lift is an endoscopic approach that uses small incisions in the scalp that are behind the hairline. This technique results in much less scarring and fewer problems with loss of sensation to the scalp and forehead.
With upper eyelid surgery, excess skin is removed from the eyelids below the brows which has no direct effect on the position of the brows themselves. However, many patients have so much excess upper eyelid skin that they unconsciously elevate their brows to lift the extra lid skin off of their lashes. Once that skin is gone, the reason for the unconscious brow elevation is gone and they naturally relax their brows. Some believe that their brow was pulled down in the surgery when, if reality, the reason for them holding their brows up was removed.
Both procedures can help with hooding of skin over the lateral part of the eyes. Most patients who have had a previous upper blepharoplasty and later believe that they need it done again are better candidates for a brow lift than another eyelid lift, unless the first eyelid surgery was not done very well or was done a long time ago. Experience plastic surgeons are generally a little more aggressive with the skin removal than are Ophthalmologists.
For patients who have a combination of low set brows as well as excess skin on their upper eyelids, both an upper blepharoplasty and a brow lift can be done at the same time. In these cases, it is necessary to be a little conservative with the upper eyelid skin excision to avoid inability to close the eyes causing corneal exposure.
Making a Decision
If you are happy with your brow position and feel that you just have extra skin on your upper eyelids, you are probably a better candidate for just an eyelid procedure. If you don’t have much excess eyelid skin but feel that your brows are too low, a brow lift is probably more indicated. For those who can’t decide which they want, the cost, venue and anesthesia helps them to make a decision. The upper blepharoplasty is generally done in the office operating room under just local anesthesia with a little oral sedation with Valium and a pain pill while the brow lift is done at an outpatient surgery center under anesthesia.