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As new ISAPS data shows eyelid surgery now leads for both women and men worldwide, Beverly Hills oculoplastic surgeon Dr. Christopher Zoumalan explains when the brow belongs in the plan

Beverly Hills, CA, Oct. 08, 2026 (GLOBE NEWSWIRE) -- For the first time, eyelid surgery was the most common cosmetic surgical procedure for both women and men worldwide in 2025, with more than 2.4 million procedures, according to the International Society of Aesthetic Plastic Surgery (ISAPS) Global Survey released September 29, 2026. As more patients seek eyelid surgery, Dr. Christopher Zoumalan, a board-certified ophthalmologist and ASOPRS fellowship-trained oculoplastic surgeon practicing in Beverly Hills, says one question is worth answering first: whether part of a heavy upper face comes from the brow. When it does, his approach is the Bella Lift, an upper face rejuvenation procedure that combines an endoscopic brow lift with upper and lower blepharoplasty, usually with fat grafting, in one planned operation.

Brow surgery is rising too. In the United States, the American Society of Plastic Surgeons (ASPS) estimates that forehead and brow lift procedures among its member surgeons rose 29 percent in 2025, according to its Procedural Statistics Report released September 1, 2026. Both surveys count procedures reported by plastic surgeons.

How the Bella Lift Works

Dr. Zoumalan developed the Bella Lift to treat the brows and eyelids as one unit. Unlike a facelift, which addresses the lower face and neck, the Bella Lift focuses on the upper third of the face. It brings three procedures together. An endoscopic brow lift repositions the brow through five small incisions concealed within the hairline. Upper blepharoplasty removes excess eyelid skin through an incision in the natural crease. Lower blepharoplasty addresses under-eye bags from inside the lower eyelid, repositioning fat rather than only removing it. In Dr. Zoumalan's practice, about 95 percent of lower blepharoplasty procedures also include fat grafting, which restores volume lost with age.

Why the Brow Is Part of the Plan

The brow is what separates the Bella Lift from eyelid surgery alone. As the brow descends with age, it pushes tissue down onto the upper eyelid and adds to the fold patients see as hooding. Eyelid surgery removes excess skin but does not change where the brow sits, so when brow descent is part of the cause, eyelid surgery alone can leave some of the heaviness in place.

Published research describes the same mechanism. A descending brow can worsen excess upper eyelid skin by pushing it further down, according to Martin and colleagues in the Journal of Cutaneous and Aesthetic Surgery (2016). Patients with low outer brows and drooping upper eyelids often find that upper eyelid surgery alone does not fully address their concerns, according to Aliyeva and Sari in Scientific Reports (2025).

"When patients tell me their eyelids look heavy, I listen, but I also look higher," said Dr. Zoumalan. "In many cases the brow has descended and is pushing tissue down onto the eyelid. Treating the eyelid alone can leave that heaviness behind. My approach starts with precise measurement of where the brow sits, because an accurate diagnosis is what makes a natural result possible."

Planning the Brow and Eyelids Together

Treating the brow and eyelids in one operation lets brow height and eyelid skin removal be set in relation to each other, rather than in separate surgeries. Large-scale data supports combining them: in a multicenter analysis of 6,126 patients by Wormer and colleagues, published in Annals of Plastic Surgery in 2018 and covering surgeries performed between 2008 and 2013, adding a brow lift to blepharoplasty posed no additional risk of major complications compared with either procedure alone.

When Volume Loss Is Part of the Picture

Upper face aging is not only a matter of descent. With age, the brows, temples and midface can also lose volume, which contributes to a tired or hollow look around the eyes. That is why the Bella Lift usually includes facial fat grafting, which transfers a patient's own fat to restore volume in those areas.

"Aging is rarely coming from the eyelid alone," said Dr. Zoumalan. "It is coming from a combination of brow descent, volume loss and skin changes together. That is why I am performing more endoscopic brow lifts than ever before, and when volume loss is present, I often combine the brow lift with fat grafting to the brow and temple area. Not every patient needs it, but when they do, that combination of lifting and restoring volume is what creates a result that looks genuinely natural rather than just tighter."

Matching the Procedure to the Patient

Before recommending a Bella Lift, Dr. Zoumalan evaluates the four factors that can contribute to a heavy upper face: the brow, the eyelid skin, the muscle that lifts the eyelid and volume loss. That evaluation includes the muscle: in a study of 2,530 blepharoplasty candidates by Eshraghi and colleagues, published in Aesthetic Surgery Journal Open Forum in 2023, 13.7 percent had undiagnosed ptosis, a weakness of that muscle that calls for a different repair. Depending on the findings, the plan may be upper blepharoplasty alone, ptosis repair or, when the brow and eyelids are both involved, the Bella Lift.

Telling these causes apart is the focus of oculoplastic surgery, a subspecialty of ophthalmology dedicated to the eyelids, the orbit and the structures around the eye, completed through fellowship training after ophthalmology residency. Because the eyelids protect the eye, eyelid closure, tear film and eye comfort are weighed alongside appearance in surgical planning.

"A natural result, to me, is one where the brow and eyelids sit in proportion to each other and the patient still looks like themselves, only more rested," said Dr. Zoumalan. "That proportion is easier to set when the brow and eyelids are planned together, and it starts with an honest evaluation of which ones need treatment."

At a Glance

The Bella Lift places incisions within the hairline, the natural eyelid crease and the inside of the lower eyelid, and most patients return to work within about two weeks. Candidacy, recovery and risks are detailed at https://www.drchristopherzoumalan.com/procedures/cosmetic-eyelid-surgery/the-bella-lift/. Individual results may vary.

About Zoumalan, MD FACS Inc.

Dr. Christopher Zoumalan, MD, FACS, is a board-certified ophthalmologist and ASOPRS fellowship-trained oculoplastic surgeon in Beverly Hills, California. His practice centers on cosmetic eyelid surgery and upper face rejuvenation, including upper and lower blepharoplasty, brow lift, ptosis repair, facial fat grafting, and the Bella Lift, his signature upper face rejuvenation procedure. With over 20 years of clinical experience, he has performed more than 9,000 procedures. He is a Fellow of the American College of Surgeons (FACS) and operates at the Quad A accredited Innovate Surgery Center in Beverly Hills, which he co-founded. His practice is located at 433 N. Camden Dr., Suite 1090, Beverly Hills, CA 90210.

Press Inquiries

Jessica Yun
operations@zoumalanmd.com
(310)-278-4000
https://www.drchristopherzoumalan.com/
433 N. Camden Dr., Suite 1090 Beverly Hills, CA 90210