Eyelid and Brow Surgery

Your Consultation and Surgical Plan

Your surgical plan begins with a detailed evaluation of your upper and lower eyelids, eyelid position, brow position, facial anatomy, and eye health. Dr. Aimé will discuss the specific changes you would like to address and determine whether upper blepharoplasty, lower blepharoplasty, brow lift, or a combination of procedures is most appropriate.

Your Eye Health and Medical History

Your medical history is particularly important when planning surgery around the eyes. Be prepared to discuss dry eye symptoms, previous eye surgery, vision changes, contact lens use, glaucoma, thyroid eye disease, and other eye conditions, as well as previous facial procedures.

Depending on your history or examination, Dr. Aimé may recommend evaluation or clearance by your primary care doctor, ophthalmologist or another eye specialist before surgery.

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Your Preoperative Visit

At your preoperative visit, your surgical plan will be reviewed along with medications and supplements that should be continued, adjusted, or stopped. Preoperative testing or medical clearance may be required depending on your age and medical history.

Nicotine products must be stopped for at least 6 weeks before and 6 weeks after surgery.

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The Days Before Surgery

Approximately one week before surgery, your prescription medications will be sent to your pharmacy so they can be picked up before your procedure. A member of Dr. Aimé’s nursing team will also call to review your surgical instructions, medications, and recovery plan and answer any remaining questions.

If your procedure is being performed awake under local anesthesia, it will typically take place at our Scottsdale office. You do not need to fast before an awake procedure and may eat and drink normally unless you are given different instructions. You may be asked to bring your prescribed medications with you to the office, depending on your surgical plan.

If your procedure is being performed under general anesthesia, you may also receive a separate preoperative call from the surgery center nursing team. You will receive specific fasting instructions and guidance about which medications and supplements to continue, adjust, or stop. You may also be instructed to take medications before surgery to help reduce pain and nausea and will receive instructions for a pre-surgical carbohydrate drink. Your prescription medications should remain at home unless you are specifically instructed to bring them with you.

You should bathe or shower the night before or morning of surgery and avoid applying lotion or other products around the surgical area. If you are having a brow lift, you should wash your scalp and hair as well. Leave jewelry at home, wear glasses rather than contact lenses, and arrive in loose, comfortable clothing with easy slip-on shoes.

Regardless of whether your procedure is performed awake under local anesthesia or under general anesthesia, you will need to arrange for a responsible adult to drive you home and stay with you during the initial recovery period.

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Anesthesia and Surgical Setting

Eyelid and brow surgery is individualized based on the areas being treated and may be performed awake with local anesthesia, with sedation, or under general anesthesia depending on the procedure and surgical setting.

Upper Blepharoplasty

For an upper blepharoplasty, Dr. Aimé carefully marks the amount of excess skin to be removed while preserving enough skin for comfortable eyelid closure. The incision is placed within the natural upper eyelid crease so that the resulting scar is typically well concealed once healed.

Excess skin is removed, and prominent fat may be addressed when appropriate. If eyelid ptosis is also being treated, the muscles responsible for raising the eyelid may be adjusted during the same procedure.

Lower Blepharoplasty

For a lower blepharoplasty, treatment depends on whether the primary concern is prominent fat, excess skin, hollowing, or a combination of these findings. Prominent lower eyelid fat may be removed or repositioned, and excess skin can be conservatively removed when appropriate.

The surgical approach and incision location are selected based on your anatomy and the changes being addressed.

Brow Lift

A brow lift repositions brow tissues when brow descent contributes to heaviness around the upper eyes. There are several ways to perform a brow lift, and the surgical approach and incision location are selected before surgery based on your brow position, hairline, hair density, degree and location of brow descent, and the amount of correction needed.

Depending on the technique, incisions may be placed within the hair-bearing scalp, along the front of the hairline, or, less commonly, just above the brow hairs. Incisions within the scalp are concealed by the hair, while hairline incisions are designed to follow the transition between the forehead and hair. A direct brow lift places the incision immediately above the brow and is reserved for selected patients in whom that approach offers a particular advantage.

Some brow lift techniques can be performed either awake under local anesthesia or under general anesthesia. These may include temporal or lateral brow lifts, gliding brow lifts, and direct brow lifts. Other techniques, particularly those performed through the hair-bearing scalp with more extensive dissection, with or without the use of an endoscope, are generally more comfortable under general anesthesia.

The goal is not necessarily to dramatically elevate the brows. Rather, the technique and degree of repositioning are tailored to the areas of brow descent and the relationship between the brows and upper eyelids (for this reason a brow lift is sometimes called a brow contouring procedure).

Combining Brow Lift and Upper Blepharoplasty

Brow descent and excess upper eyelid skin frequently occur together. When a brow lift and upper blepharoplasty are combined, the brow is repositioned first. Raising the brow changes the amount of skin resting over the upper eyelid, so the eyelids are reassessed after the brow has been treated before determining how much eyelid skin should be removed.

This sequence helps avoid removing too much upper eyelid skin and preserves enough skin for the eyelids to close comfortably and completely, which is important for protecting the surface of the eye.

Combining Eyelid and Brow Surgery With Other Procedures

Eyelid and brow surgery can also be combined with fat transfer when volume loss or hollowing contributes to the appearance around the eyes or elsewhere in the face. Fat may be placed in areas such as the temples, upper eyelid region, lower eyelid-cheek junction, or other areas of facial volume loss when appropriate.

Depending on your goals and overall surgical plan, eyelid or brow surgery may also be performed at the same time as other facial or non-facial procedures. Dr. Aimé will determine which procedures can be safely and reasonably combined based on the extent of surgery, anticipated recovery, anesthesia, and your overall health.

Recovery varies depending on whether you have upper eyelid surgery, lower eyelid surgery, brow lift, or a combination of procedures. Eyelid procedures performed awake under local anesthesia often have a relatively quick physical recovery, although visible swelling and bruising may take longer to resolve. Brow lift recovery varies depending on the technique used and whether it is combined with other procedures.

Early Recovery

Swelling and bruising around the eyes are expected after eyelid and brow surgery. The eyelids may temporarily feel tight, swollen, dry, irritated, or watery, and vision may be mildly blurry from swelling or the ophthalmic ointment used after eyelid surgery. Headache, tightness, or pressure are common after brow lift surgery. Temporary numbness of the forehead or scalp can also occur and usually improves as the nerves recover.

You will need a responsible adult to drive you home and stay with you during the initial recovery period, regardless of whether your procedure is performed awake under local anesthesia or under general anesthesia. Even after an awake eyelid procedure, ointment and swelling around the eyes can temporarily blur your vision.

Sleep with your head and upper body elevated to help reduce swelling. Cool compresses may be used gently around the surgical area. You may shower and gently wash your face and hair beginning the day after surgery. Eyelid incisions can be cleaned with a moistened Q-tip.

Eye and Incision Care

After eyelid surgery, you will be given ophthalmic antibiotic ointment to use as directed. Artificial tears and lubricating gel eye drops may also be recommended to help keep the eyes comfortable while swelling resolves.

Temporary swelling can prevent the eyelids from closing completely during sleep, which can contribute to dryness and irritation. Avoid sleeping beneath an overhead fan during the early recovery period, as moving air can further dry the surface of the eyes.

Brow lift incisions are typically kept dry or moisturized with Vaseline while they heal. A head wrap is often placed after brow surgery to provide gentle compression and can generally be removed the following day.

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Activity and Restrictions

Light activity and walking are encouraged soon after surgery, but strenuous exercise, heavy lifting, bending, and other activities that significantly increase pressure in the head and face should be limited during early healing.

Return to work and social activities often depends less on discomfort and more on the amount of visible swelling and bruising. Patients having a smaller awake upper eyelid procedure may feel physically well relatively quickly, while lower eyelid surgery, brow lift, combined procedures, or more extensive surgery may require additional recovery time.

Exercise and other activities can be gradually resumed as healing progresses. Dr. Aimé will provide specific restrictions based on the procedures performed.

Incision and Scar Care

Incisions may initially appear pink or more noticeable before gradually softening and fading. Brow incisions hidden within the hair typically become difficult to see once healed, while eyelid and hairline scars continue to mature over several months.

Once the incisions are fully closed and healing appropriately, Dr. Aimé will provide guidance on scar care and sun protection based on the location and type of incision.

How Your Eyes and Brows Change During Healing

Swelling can temporarily change the shape and position of the eyelids and brows, and one side may swell or heal differently from the other. The brows may initially appear higher or more elevated than the final result, while eyelid swelling can temporarily make the eyes appear smaller, uneven, or as if they still have excess skin.

As swelling resolves, the eyelids become more defined and the brows gradually settle into their intended position. Temporary tightness, numbness, tingling, itching, or changes in sensation can occur as the tissues and nerves recover. Scalp numbness after brow lift is usually temporary but may take longer to resolve than the visible swelling.

Your appearance will continue to evolve over the following weeks and months as swelling resolves, incisions mature, and the tissues settle.

Postoperative Follow-Up

Dr. Aimé will check in with you after surgery, and you will have her direct contact information should questions or concerns arise during your recovery.

Follow-up visits allow Dr. Aimé to evaluate your incisions, eyelid closure, swelling, brow position, eye comfort, and overall healing. Sutures are removed when appropriate based on the procedure and incision location (usually within 1 week of your procedure).

Additional visits allow Dr. Aimé to monitor scar maturation, sensation, eyelid and brow position, and the continued evolution of your results.