TL;DR: "Should I do my eyelids, neck or brow at the same time as the facelift?" is one of the questions we are asked most, and our own records show why: of the 31 facelift cases in the Medical Korea Service sales ledger, 21 (68%) were combined with at least one other procedure — most often the neck, then the brow, then the eyelids. The best large dataset on the question, 11,300 facelift patients in a prospective US insurance registry, found that combining is common there too (57.4%) and that it roughly doubles a low risk: major complications of up to 3.7% for combined operations against 1.5% for a facelift alone, with combined procedures an independent risk factor for infection. But the combination matters more than the count. In 6,126 eye-surgery patients from the same registry, adding a brow lift to blepharoplasty added no measurable risk, while the clot-risk data show that the steep rise comes from adding body procedures, not facial ones. This article sets out those numbers, the anatomical reason why brow and eyelids should be planned together in Asian faces, what two of our own patients chose, and the questions that decide whether combining is sensible for you. Medical Korea Service is a Registered Facilitator for International Patients (Seoul Metropolitan Government, Reg. No. A-2014-01-01-1414, registered 23 July 2014).
Why this question comes up so often
For a patient flying to Korea, combining has an obvious appeal: one trip, one anaesthetic, one recovery, one period away from work. Most people also notice, once they look closely in a mirror, that ageing does not stop at the jawline. The upper eyelids hood, the brow sits lower than it used to, the neck loosens. A facelift addresses the lower face and jawline; it does not by itself change the eyelids or lift the brow.
So the question is reasonable. The honest answer is neither "always" nor "never". It depends on which procedures, on you, and on how long the combined operation will take — and there is enough published data now to say something more useful than "ask your surgeon".
What our own ledger shows
We went back through the Medical Korea Service sales ledger and counted every entry that included a facelift. There are 31. The table shows what else was done in the same operation.
| Facelift cases in the MKS ledger (n = 31) | Cases | Share |
|---|---|---|
| Facelift alone | 10 | 32% |
| Facelift combined with at least one other procedure | 21 | 68% |
| — of which: neck | 15 | 15 of 21 |
| — of which: brow / forehead | 11 | 11 of 21 |
| — of which: eyelids | 10 | 10 of 21 |
| — of which: fat grafting | 8 | 8 of 21 |
| — of which: nose | 2 | 2 of 21 |
| Three or more procedures in one operation | 7 | 7 of 31 |
How we counted, and why you should hold these numbers loosely: we searched the full text of each ledger entry for procedure names. A procedure that was done but not written down is under-counted; one that was only discussed in a consultation note may be over-counted. The sub-rows overlap because many patients had more than one addition. This is the same method we used for the age breakdown in our facelift-by-age article, and it is a small, single-company sample — useful for showing what patients actually choose, not for estimating risk.
Two things stand out. First, combining is the norm among our patients, not the exception. Second, the neck is by far the most common companion. That is less of a separate decision than it looks: in most modern facelift techniques the lower face and neck are lifted through connected incisions, so many surgeons plan them as one operation rather than as two procedures bolted together.
What combining does to risk — the large studies
According to PubMed, the most useful evidence comes from CosmetAssure, a US insurance programme that prospectively recorded every major complication — defined as one requiring an emergency-room visit, hospital admission or reoperation within 30 days — across more than 129,000 cosmetic operations by board-certified plastic surgeons between 2008 and 2013. Several analyses of that registry answer our question directly.
| Study | Patients | What it found about combining |
|---|---|---|
| Gupta et al., Aesthet Surg J 2016 | 11,300 facelifts | 57.4% were combined with another cosmetic procedure. Overall major complication rate 1.8%; hematoma 1.1%, infection 0.3%. Up to 3.7% for combined operations vs 1.5% for facelift alone. Combined procedures raised infection risk (relative risk 3.5); BMI of 25 or over also did (2.8). Male sex was the strongest predictor of hematoma (3.9). |
| Winocour et al., Aesthet Surg J 2017 | 129,007 cosmetic operations | Clinically significant blood clots (VTE) in 0.09%. 0.20% after combined procedures vs 0.04% after single procedures. The risk rose most with procedures on the trunk and limbs, and with BMI and age. |
| Wormer et al., Ann Plast Surg 2023 | 6,126 eye-surgery patients | Overall major complication rate 0.4%. 806 had blepharoplasty and brow lift together. Adding a brow lift to blepharoplasty posed no additional risk of major complications. |
| Hjelm et al., Facial Plast Surg 2019 | 46 combined cases (single centre) | Endoscopic brow lift with blepharoplasty did not increase complications. Smoking was the only factor that trended towards more complications. |
Read together, the pattern is consistent. Combining raises risk, but from a low base, and not evenly. Upper-face combinations — brow with eyelids — showed no measurable increase. The biggest jump in clot risk came from adding procedures on the body, which is why a "face plus tummy plus liposuction" trip is a different decision from "face plus eyelids". The facelift figures sit in between: roughly double the complication rate when combined, with infection the complication that rises.
Why brow and eyelids belong in the same conversation — especially for Asian faces
There is a specific reason not to plan the eyelids in isolation. Many people with heavy upper lids unconsciously raise their brows all day to keep their eyes open; the forehead muscle is doing the lifting. Remove the excess eyelid skin and that stimulus disappears — the brow can settle lower than before.
A Korean surgeon's review of 518 Asian patients described exactly this: after upper blepharoplasty or below-brow excision, patients who had been compensating with the forehead muscle showed true brow ptosis, and the degree varied from person to person. The author's stated purpose was to help surgeons avoid "angry or tired-looking eyes" after eyelid surgery (Park, Aesthetic Plast Surg 2024). A separate review on forehead lifts in Asians concluded that, because of Asian anatomy, a forehead lift should be considered beforehand when blepharoplasty is planned (Kim and Kim, Facial Plast Surg Clin North Am 2021).
This is not universal. In a Dutch series of 140 patients having upper blepharoplasty for impaired vision, the women's brows did not drop significantly; only in the 14 men was a slight lowering measured (Huijing et al., J Plast Reconstr Aesthet Surg 2014). The practical point is that brow position should be assessed before the eyelid plan is fixed — which is an argument for deciding brow and eyelids together, whether or not both are done.
How Asian skin, fat and ligaments change the facelift itself is covered in our Asian facelift anatomy article.
Two patients, two plans
Two of our patients agreed to share short videos, which are on our patient voices page. We describe them here only as they are published there.
Imelda, Chinese-Indonesian, had a facelift and nose surgery together in 2024. In her published words: "What surprised me most was the honesty. James told me what surgery could and couldn't do — before I even paid a deposit."
Desi F., also Chinese-Indonesian, had a mini facelift on its own in 2024: "The specialist James introduced understood exactly what I wanted. Natural, refined — not overdone."
We include them not as proof of anything — two patients prove nothing statistically — but because they show the decision in miniature. One combined; one deliberately kept it to a single, smaller procedure. Neither answer is the default. Both patients chose after being told what surgery could and could not do.
When combining is usually reasonable, and when to stage
The factors below come from the studies above. They are the things we ask about before a combined plan goes to a surgeon, and the things your surgeon will weigh.
| Factor | What the evidence says | What it means for your plan |
|---|---|---|
| Which procedures | Brow + eyelids: no added major risk (6,126 patients). Adding body procedures: largest rise in clot risk (129,007). | Face-only combinations are a different decision from face-plus-body. Ask whether body work could be a separate trip. |
| Sex | Male sex: relative risk 3.9 for hematoma after facelift. | Men should ask specifically how hematoma is prevented and monitored, and budget for a longer stay near the clinic. |
| Body weight | BMI 25 or over: relative risk 2.8 for infection; BMI also raised clot risk. | Combining raises infection risk independently; the two stack. Discuss both with the surgeon. |
| Smoking | The only factor trending towards more complications in combined brow–eyelid surgery. | Stop well before surgery — see our preparation guide. |
| Length of operation | Not separately measured in these abstracts. | Ask for the estimated total operating time and anaesthesia type in writing, and whether any part could be staged. |
What these numbers cannot tell you
The registry figures come from US board-certified surgeons operating on insured patients, and count only complications serious enough to need an emergency visit, admission or reoperation within 30 days. Minor problems, asymmetry and dissatisfaction are not in them. The facelift study reports combined procedures as a group; its abstract does not break the 3.7% down by which procedure was added, so we cannot tell you the specific figure for facelift plus eyelids. None of these studies was done in Korea. And our own ledger is 31 cases counted by keyword — it shows what patients chose, not how they fared.
How we handle this
When a patient asks to combine, we send the surgeon the full list rather than the facelift alone, and ask for the plan back in writing: which procedures together, the estimated operating time, the anaesthesia, and whether the surgeon would stage any part. Where brow and eyelids are both in question, we ask for the brow to be assessed before the eyelid plan is fixed. Recovery for a combined operation follows the slowest component, so the flight home is planned around that — see our recovery timeline. If a combination looks unwise for you, we say so before any deposit, and how we choose the surgeon in the first place is set out in how we verify Korean plastic surgeons.
Frequently asked questions
Is it safe to combine a facelift with eyelid surgery?
In large registry data, combining procedures with a facelift raised the major complication rate from 1.5% to up to 3.7% — roughly double, from a low base — with infection the complication that rose. Upper-face combinations such as brow lift with eyelid surgery showed no added major risk. Whether it is sensible for you depends on your health, sex, weight, smoking and the total operating time.
Which procedure is most often combined with a facelift?
In our own ledger of 31 facelift cases, the neck was the most common addition (15 of the 21 combined cases), followed by brow or forehead (11) and eyelids (10). In many techniques the lower face and neck are lifted through connected incisions, so they are often planned as one operation.
Should I have my eyelids done before or with a brow lift?
Brow position should be assessed before the eyelid plan is fixed. Removing upper-lid skin can take away the reason the forehead muscle was lifting the brow, and a lower brow can then show — a pattern described in a Korean series of 518 Asian patients. Deciding the two together avoids a "tired or angry" look afterwards.
Does combining procedures raise the risk of blood clots?
Yes, but the absolute numbers are small. Across 129,007 cosmetic operations, clinically significant clots occurred in 0.20% after combined procedures against 0.04% after single ones, and the rise was greatest when procedures on the trunk or limbs were included.
Will combining make my recovery longer?
Recovery follows the slowest component of the operation, so a combined plan usually means planning your stay and flight around the procedure with the longest recovery. Ask the surgeon for the expected timeline in writing before you book flights.
Related reading: Facelift in Korea by age: what changes at 40, 50 and 60+ · Why Asian faces need a different facelift plan · Before a facelift in Korea: anaesthesia, medications to stop and what to bring · When facial surgery abroad goes wrong: what the case series report · Day-by-day recovery and when it is safe to fly home · Facelift in Korea — how we match you to a verified specialist
This article was prepared by Medical Korea Service as general information for patients considering combined facial surgery. It is not medical advice and does not replace the written instructions of your surgeon, which govern in every case. All study figures are quoted from the peer-reviewed sources linked in the text, retrieved from PubMed abstracts. MKS ledger figures are a keyword count of 31 internal records and carry the limitations stated above. Patient quotations are reproduced as already published, with consent, on our patient voices page. No clinic or surgeon is named.