Most people who come in asking about a facelift point at their eyes. Most people who come in asking about their eyes are bothered by their jawline. They are two different operations, and knowing which is which is most of what a consultation is for.
They are different problems
The face usually portrays the first visible signs of aging. Gravity and diminished volume are the two forces at work, but they show up in different places at different rates — and the operation that fixes one does not touch the other.
A facelift works below the skin. Over the years the procedure has changed from simple skin lifting to more complex deeper-plane techniques. Incisions are usually made in front of and behind the ear and may extend into the scalp; the deeper layers of the face are lifted, muscle is tightened, liposuction of the neck and jowls may be performed, and excess skin is removed or repositioned. What changes is the jawline, the jowls and the neck.
Blepharoplasty — eyelid surgery — works on the eyelids themselves. Upper blepharoplasty addresses the heavy, hooded upper lid. Lower blepharoplasty addresses the puffiness and shadowing beneath the eye. What changes is how rested you look.
A facelift will not open a heavy upper lid. Eyelid surgery will not lift a jowl. If the mirror bothers you in both places, you are looking at both operations.
The two-minute self-check
Stand at a mirror in ordinary daylight, not bathroom light, and look straight ahead.
- Lift the skin at your temples with two fingers. If the jawline sharpens and the neck tightens, that is the facelift conversation.
- Now look at the upper lid. If skin rests on your lashes or you catch yourself raising your brows to see, that is the upper blepharoplasty conversation.
- Look underneath. Bags that are there in every photograph, in every light, are the lower blepharoplasty conversation.
- Raise your brow with a finger. If that is what fixes the heaviness, the answer may be a browlift rather than eyelid surgery at all.
Why they are so often done together
Combining procedures means one anaesthetic and one recovery instead of two. It also means the result is balanced: a lifted jawline under tired eyes tends to read as odd rather than refreshed, because the eyes are where people look first.
The patient in our most recent case had a facelift with upper and lower blepharoplasty in a single operation — a common, deliberate pairing rather than an add-on.
Facelift with upper and lower eyelid surgery
Four matched before-and-after views, unretouched.
What a consultation actually settles
Photographs, an examination, and a conversation about what specifically bothers you. Most patients requesting evaluation for a facelift feel that their facial features do not reflect their youthful spirit and energy level — the job of the consultation is to translate that into which tissue needs to move, and how far.
Dr. Carlin has practised aesthetic plastic surgery in Columbia since 1998 and limits his practice to the face, breast and body. Surgery is performed in the practice's own private surgery center in West Columbia. The office is open Monday through Thursday, 8:30 to 5:00, and closed Friday. We do not accept insurance.
C. Brett Carlin, M.D., F.A.C.S.
Dual board-certified by the American Board of Surgery and the American Board of Plastic Surgery. Duke University Medical Center fellowship. Practising in Columbia since 1998.
About Dr. Carlin →