At my pre-op the surgeon suggested adding a brow lift and upper eyelids and my quote has nearly doubled. Is this normal or am I being upsold?

Some of you helped me last month when I was trying to work out whether a mini would do, and you were right, it wouldn't. I'm booked in for a SMAS lift with neck work in July with the second surgeon.

Then I went for my pre-op yesterday and he held a mirror up, lifted my brows with two fingers, and said the lift will do a beautiful job of my jaw and neck but my eyes will "look older than the rest of you" afterwards, and would I consider adding a brow lift and upper lids while I'm under. My quote has gone from a number I'd made peace with to nearly twice it.

Now, he was not pushy. He said think about it and phone the office. But I walked to the car park absolutely certain of two contradictory things: that he's right, because I do look permanently unimpressed, and that I've just been sold three operations by a man who two months ago was selling me one. How do you tell the difference between a surgeon being thorough and a surgeon adding items to a basket?

The two-fingers-on-the-brow move is real, and it is also the single most effective sales gesture in aesthetic surgery, so I understand the whiplash entirely.

Here's my honest ledger, since I said yes to a combination. Deep plane plus upper lids, one anaesthetic, one recovery. I don't regret the eyes at all, they made more difference to how awake I look than anything else. What I underestimated was the recovery. My face and my eyes healed on completely different schedules and the lids were the bit that made me look properly operated-on in photographs for weeks longer than the lift did. Nobody told me the two would be out of step and I spent a fortnight convinced something had gone wrong with my eyes specifically.

Would I do it again? Yes. Would I have booked it the same afternoon he suggested it? No.

Gail, two things that helped me hold my nerve when mine suggested adding things.

First, ask him to tell you what he would recommend if you could only afford ONE of the three. Not as a negotiating tactic, genuinely as a question. A surgeon with an opinion will answer it in about four seconds and the answer tells you which part of your face is actually the problem. A surgeon selling a package will get vague.

Second, ask what happens if you have the lift now and the eyes in two years. Because the honest answer is usually "nothing terrible, you'd have a second smaller recovery and a second facility fee", and once you know that, the "while you're under" argument stops sounding like a deadline. It's an argument about convenience and money, which are real, but they are not medical urgency and they shouldn't be dressed up as it.

I had the lift alone. My eyes are still my eyes. It has not ruined anything.

GailS61 said:

my eyes will "look older than the rest of you" afterwards

This exact sentence was said to me too, almost word for word, by a different surgeon in a different city, which either means it's a genuine clinical observation or it's in a script somewhere. I've never worked out which.

I said no and had the lift on its own in January. And I will be honest with you: he was a bit right. My jaw and neck are lovely and my eyes are the tiredest thing about my face now. But I also had ONE recovery instead of two overlapping ones and I was very glad of that in week two.

The direct answer, Gail, is that the observation is almost certainly honest and the timing of it is the part worth questioning.

Why the observation is legitimate: a facelift addresses the lower face and neck, the jowls and jawline and the sagging under the chin. It does not treat the forehead, the brow or the eyelids at all. Those are separate operations on separate anatomy, a brow lift and eyelid surgery, and it is genuinely common for a well-lifted lower face to make a heavy brow or a hooded upper lid more noticeable than it was. The site sets out that boundary in what a facelift will not fix, and the specific comparison in facelift versus blepharoplasty. So the surgeon is not inventing a problem to sell you a solution.

Now the number that belongs in your decision, because it rarely gets offered alongside the quote. Combining procedures raises the overall complication rate: roughly 3.7% for combined surgery against about 1.5% for a facelift alone. Those are small figures and they are also real ones, and they exist because a longer operation means a longer anaesthetic, more dissection and more tissue healing at once. Set against that, one anaesthetic and one recovery instead of two is a genuine benefit, not merely a sales line. The trade is legitimate in both directions, which is exactly why it should be made deliberately rather than in a car park.

Rosemary's question is the one I would put to him, and I would add a second: what is the plan if one part heals slower than the other, which as Annelise found is common rather than exceptional. And a practical caution on the money. A quote that nearly doubles should itemise. Surgeon fee, anaesthetist, facility, follow-up and, crucially, what a revision would cost and who pays for it. That itemisation is a reasonable request and how a practice responds to it is informative in itself, as choosing a facelift surgeon sets out.

What I cannot tell you from here is whether your brow needs lifting. He has examined you and I have not. Go back and ask; a surgeon who is right will not mind being asked twice.

Update, and thank you, because the "if I could only afford one" question worked exactly as advertised. He answered instantly: the neck, then the lids, and the brow last because in his opinion mine is borderline and he would not push it.

So: lift and neck as booked, upper lids added, brow dropped. The quote came down from the scary number, it's itemised now including what a revision would cost me, and I feel like I chose rather than was sold to. Still terrified about July, but terrified about the right things.