The treatment of older patients with lax and drooping upper lid skin presents the surgeon with a completely different cosmetic challenge. In addition to blepharoplasty, the surgeon has to consider the amount of excess upper lid skin, and in older Asian patients, upper lid bloating due to sagging skin on the forehead adds to the complexity of upper lid surgery. These patients do not want to see the ugly appearance caused by edema and swelling that persists after upper lid surgery. These problems are primarily due to the extensive removal of thin skin in front of the lid and the downward migration of thick skin near the brow area to the eyelid. A forehead lift can adequately address these problems; the thick skin at the brow is lifted and the thin skin in front of the lid is used to create a fine blepharoplasty fold. For older Asian adults, a forehead lift has another purpose: to stop the postoperative accumulation of thick skin near the eyelid line, and is appropriate for those who had double eyelids in their youth, who have a triangular eye pattern due to age-related sagging of the upper lid skin and thick crow’s feet in the outer corners of the eyes. In addition the surgery removes as little or no muscle and fat tissue as possible to avoid a sunken appearance of the eye. However, for patients whose eyebrows are too far from the lid margin or whose eyeballs are protruding, forehead lift or upper eyebrow brow cut is not suitable. Instead, a lower eyebrow cut and blepharoplasty can be used to solve both the problem of loose upper lid skin and the problem of wide eyebrows from the lid margin. The specific surgical procedure chosen should be individualized and not one-size-fits-all.