Male blepharoplasty

What it treats

• Eyelid surgery is among the top 5 surgical procedures performed on men worldwide, alongside gynecomastia, liposuction, rhinoplasty and facial fat grafting; men were 14.5% of all aesthetic surgery patients in the most recent global survey (PMID 39103642).
• In a population-based study of 3,267 adults 60 and older in Tehran, dermatochalasis (55.15% overall) and floppy eyelid syndrome (0.25% overall) were both significantly more common in men on multivariate analysis (PMID 42351045).
• Periocular asymmetry, measured by 3D photogrammetry in 301 Caucasian subjects, was more prominent in men: the absolute difference in upper eyelid crease between the two eyes was 0.90 mm in men against 0.65 mm in women (p<0.05) (PMID 38806825).
• Sex differences in eyelid and brow anatomy vary by measurement and by population studied. In 1,000 adult Nigerian eyes, brow height differed significantly by gender (men 13.1 ± 2.4 mm, women 13.6 ± 2.7 mm, p=0.029), while horizontal and vertical palpebral fissure, upper lid crease and margin reflex distance did not (PMID 22813784).
• In 162 young Chinese adults, palpebral fissure length and height, outer canthal width and two aesthetic indices differed by gender (p<0.05), but crease height itself did not (PMID 26395280).
• Crease height varies more by ethnicity than by sex within a single region: in 101 southern Thai subjects (51 men, 50 women) across 4 ethnic groups, mean upper lid crease was 7.1 mm in Thai, 4.0 mm in Chinese, 6.6 mm in Thai-Malay and 4.4 mm in Thai-Chinese subjects, with male and female measurements following similar patterns within each group (PMID 21534366).
• In 213 subjects without eyelid complaints, mean eyebrow height (inferior corneal limbus to brow) was 19.4 mm in men and 19.7 mm in women, a difference that was not statistically significant; race, not sex, was linked to eyebrow height in that data set (PMID 20724865).
• In 222 men specifically, the male eyebrow followed the bony orbital rim with a flat contour; brow ptosis was present in 7.4%, and mean brow position did not change with age, though deep-set eyes were linked to a lower brow (PMID 16052142).
• Eyebrow shape, not just height, differs by sex and changes with age: a morphometric study of 244 people found the brow rises with age and female brow shape becomes more male-like over time (PMID 30819648).

How it is done

• The stated surgical goal in men is conservative tissue excision that preserves eyelid fullness and avoids feminizing the result; overcorrection is described as a cause of a feminized appearance requiring a conservative approach (PMID 40854548).
• Upper and lower blepharoplasty in men are reviewed as anatomically similar in principle to the procedures in women, with surgical approach and goals adapted to male aesthetic norms (PMID 38936995).
• Lower lid technique in men: a transconjunctival approach, sometimes extended retroseptally, is described as preferred, with fat excised or redraped and orbitomalar ligament release used to address the palpebromalar and nasojugal grooves; lid-support procedures are described as critical to prevent lower lid malposition (PMID 35367031).
• An earlier review of the male lower lid also centers on the transconjunctival skin-muscle flap approach and techniques for displaced orbital fat, framed around male-specific aesthetic goals (PMID 18620982).
• In Asian male patients, blepharoplasty is reviewed alongside rhinoplasty with attention to anatomical and aesthetic considerations specific to this group, without a single universal crease height given (PMID 38936994).
• Crease-height data that include male subjects: in 153 Asian adults (66 men, 87 women) rated for eyelid beauty, the vertical palpebral fissure, height of the double fold, lid crease height and height of the closed eyelid differed significantly between the most-beautiful, average and less-beautiful groups in both sexes; the study proposes a brow-to-crease height ratio of 1.2:1 (PMID 31754748).
• Brow lift technique choice differs by sex in practice: in a survey of 1,060 patients from one surgeon, women mostly had endoscopic brow lifts (83.8%), while men mostly had direct brow lifts (63.1%), followed by endoscopic lifts (16.5%) (PMID 40016580).
• In a series of 50 men having direct brow lift with blepharoplasty, significant brow elevation was achieved in 98% of patients at 12 months, with a visible scar in 2 (PMID 27274124).
• Gender-affirming brow surgery sits at the opposite end of the same anatomy: a review of brow lift and brow position for gender affirmation describes techniques to raise and arch the brow when feminization, rather than masculine preservation, is the surgical goal (PMID 35752488).

Results and evidence

• Among men undergoing aesthetic eye surgery in a multicenter CosmetAssure analysis of 6,126 patients, blepharoplasty alone was the most common procedure, followed by combined blepharoplasty-brow lift and then brow lift alone (17.6% vs 12.9% vs 10.7% of each group being male, p<0.01) (PMID 29369102).
• Motivation for surgery differs by sex: in 100 blepharoplasty patients (50 men, 50 women), social embarrassment was cited more by men (63.6%) than women (36.4%), while looking younger was overwhelmingly a female motivation (89.3% of women against 10.7% of men) (PMID 40351738).
• In that same 100-patient study, eye heaviness, a functional rather than purely cosmetic concern, was a shared complaint across sexes in the 30-35 age bracket (57.1%) (PMID 40351738).
• Brow position after upper blepharoplasty alone (without brow lift) drops more often in men: in 70 patients, brow position was lower postoperatively in 58.3% of men against 29.3% of women (PMID 27308242).
• Perceived rejuvenation from blepharoplasty, measured with facial recognition software in 94 patients (84% female), showed an average 3.2-year reduction in estimated age after surgery; this age-reduction effect was not associated with patient gender (P > 0.05) (PMID 40167099).

Risks and complications

• Male gender was an independent predictor of wound dehiscence after upper blepharoplasty in a 2,376-eyelid review (p=0.0062), alongside fast-absorbing plain gut suture (PMID 32852369).
• Men are described as predisposed to lower lid malposition, visible scarring and wound dehiscence because of anatomical and skin-thickness factors specific to the male eyelid (PMID 40854548).
• In a 32-patient series of facelift with blepharoplasty under a strict blood-pressure protocol, men had higher mean postoperative systolic blood pressure than women (p=0.05), a recognized risk factor for hematoma (PMID 38714536).
• Overcorrection in men is described as a specific cause of feminization of the upper eyelid and brow, distinct from the complications (asymmetry, dry eye, lagophthalmos) that affect both sexes (PMID 40854548).

Recovery

• The male-specific risk factors identified in the literature are wound-healing risks, not a different overall timeline: male sex raises the odds of wound dehiscence (PMID 32852369) and of postoperative blood pressure elevation linked to hematoma (PMID 38714536).
• No study identified in this review reports a recovery timeline (swelling, bruising, return to work) broken out separately by sex. General recovery evidence, not sex-specific, is covered in Blepharoplasty recovery timeline.

Combined procedures

• Brow lift combined with blepharoplasty did not raise the major complication rate over either procedure alone in the 6,126-patient CosmetAssure series (0.4% combined vs 0.4% blepharoplasty alone vs 0.7% brow lift alone, p=0.65) (PMID 29369102).
• Brow lift technique in men leans toward direct and midforehead approaches more than endoscopic lifts, reviewed in detail with technique-specific outcomes in Browpexy and direct brow lift, Endoscopic brow lift and Temporal and lateral brow lift.
• Lower lid and midface technique choices relevant to men, including fat repositioning and tear trough correction, are covered in Lower blepharoplasty and Tear trough and lid-cheek junction surgery.
• Asian male blepharoplasty is reviewed together with Asian male rhinoplasty as procedures commonly requested together in that population (PMID 38936994).

Current questions

• Normative anthropometric studies disagree on whether eyebrow height itself differs by sex: a Nigerian cohort found a significant difference (PMID 22813784), while a separate 213-subject study found none, attributing more variation to race than to sex (PMID 20724865). Neither was conducted specifically in surgical blepharoplasty candidates.
• "Feminization" as a surgical complication is described qualitatively in the male blepharoplasty literature (overcorrection, loss of brow flatness, arching) but is not quantified with a validated scale or measured outcome rate in the papers reviewed here (PMID 40854548).
• Direct comparative outcome data between men and women having the same blepharoplasty technique, beyond brow position and wound dehiscence, were not identified in this review; most sex-specific findings come from anthropometric or epidemiologic studies rather than from surgical outcome trials.
• The decision-making study comparing male and female motivations enrolled 100 patients at a single center, a sample too small to generalize internationally (PMID 40351738).
• Whether the male brow becomes more feminine-shaped with age at the same rate as it does in women, and what that means for surgical planning in older male patients, is raised but not resolved by the morphometric aging data (PMID 30819648).

Terms

• Feminization (surgical): an unintended shift toward female eyelid or brow appearance, described in the literature as a risk of overcorrection in male blepharoplasty (PMID 40854548).
• Dermatochalasis: excess, lax eyelid skin, more common in men in at least one population-based study (PMID 42351045).
• Floppy eyelid syndrome: lax, rubbery upper eyelids that evert easily, more common in men (PMID 42351045).
• Periocular asymmetry index: a measured difference between the right and left periocular region, more pronounced in men in 3D photogrammetry data (PMID 38806825).
• Transconjunctival approach: a lower lid incision made inside the eyelid, avoiding a visible skin scar, favored in male lower lid blepharoplasty (PMID 35367031).
• Orbitomalar ligament: a retaining ligament released in some lower lid techniques to correct the palpebromalar groove (PMID 35367031).
• Brow-to-crease ratio: the proportion of lower-brow-margin height to eyelid crease height, proposed at 1.2:1 for an aesthetically favored Asian eyelid in a mixed-sex study (PMID 31754748).
• Inferior corneal limbus to brow (ILB): a standardized measurement of eyebrow height (PMID 20724865).
• Gender-affirming brow surgery: procedures to raise and arch the brow toward a typically female position, the aesthetic opposite of male-pattern brow preservation (PMID 35752488).

Papers