What sort of procedures can I look into to significantly improve the appearance of my eyes? (Photo)

My eyes have led me to have zero confidence and self esteem. People have commented on them since I was in my young teens. As you can see, my eyes appear droopy. The upper eyelids appear very puffy and it looks as if the brows are weighing down on the eyelids themselves. Also my lower eyelids appear to dip and are not straight like most lower eyelids. Furthermore, there are skin folds covering my tear ducts. I feel like my eyes need a lot of work to get them looking "normal".

Doctor Answers (6)

Nonsurgical & Minimally Invasive Procedures Can Improve The Appearance Of Tired Looking Eyes And Droopy Upper Lids

+2
From the three photos provided, there is evidence of circles under the eyes, flattening of the upper cheek and of early tear trough development.There also appears to be ptosis (sagging) of the brows that gives rise to the appearance of the sagging and puffiness in that region and which is causing a large portion of the upper lids to be obscured. 

The use of fillers, such as Belotero Balance combined with a small amount of a whitish-colored calcium-based filler, Radiesse, injected into the darkened, hollowed areas of the lower lid can restore both the lost volume to the region and lighten the color. There is also a suggestion of slight flattening of the wing of the upper inner cheek to the sides of the nose. A small amount of Juvederm UltraPlus XC injected directly into this region would not only revolumize the area, but would serve to provide more appropriate fullness, in addition to secondarily buttressing the region (i.e. providing a platform)  under the eyes.  Injections take only about ten minutes to perform and, in fact, is a nonsurgical approach often used these days in lieu of eyelid surgery to treat crinkles, tear troughs, hollows and dark circles.

To improve the upper lids, a nonsurgical browlift (check out the archives of Realself.com for more details), using volumizing fillers and Botox might be helpful for raising the brows a bit and improving the problem. However, with this degree of ptosis, The Ten Minute Eyelift, a procedure I developed over fifteen years ago, would be my first choice.

The technique is quite simple in experienced hands and literally takes about five minutes per side to complete. The "underbelly" of the excess skin (the part hidden from view) is first anesthetized with local anesthetic--making the procedure painless. Next, the focal areas to be treated are marked in a discontinuous, fractionated fashion--not in a continous line-like fashion. Finally, a simple cautery is then used to treat these focal areas

Almost immediately, the skin contracts vigorously in response to the probe, drawing the hooded portion of the lid backwards and upwards over the surface of the underlying normal lid. As it does so, the underlying eyelid is exposed and restored. Each wound is then covered with only a small amount of antibiotic ointment and left to heal spontaneously. The discontinuous, focal, nature of the little wounds typically leaves barely visible marks when completely healed--very much like when a dermatologist removes keratoses or skin tags from the upper lids in this fashion.

Healing is usually complete in seven to ten days. Slight bruising and mild swelling are common afterward and may take about a week before becoming less noticeable. Cold compresses can be used in the first 48 hours to minimize the bruising and swelling. This may be supplemented by the oral use of bromelain for three days. Bromelain, an enzyme, is a pineapple derivative that has demonstrated usefulness in preventing bruises and speeding their resolution. Pain medications are seldom necessary, but for some people who experience mild discomfort, acetaminophen (Tylenol) is ordinarily adequate. Most people can return to work the following day. I performed the procedure on myself a number of years ago standing in front of a mirror and hours later took a twelve hour transatlantic flight.

One treatment is ordinarily all that is required. The results are permanent and can be fully appreciated in just two weeks. When completely healed, faint, narrow, ivory or off-white lines are often all that can be seen at the treatment site, which are not visible when the eyes are open.

Consultation with a board certified core aesthetic physician with expertise and extensive experience in treating the periorbital area is strongly advised.


New York Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

Upper lid blepharoplasty and correction of epicanthal fold should provide a good aesthetic result.

+2
In the photograph there is very little upper lid showing with Apparent fat herniation into the lid. There is also a fold of skin in the area between the nose in the lid they can be easily corrected.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 7 reviews

Upper and lower blepharoplasty

+1
An upper blepharoplasty can remove the excess skin and herniated fat in the upper lids creating the hooded look. The incision is placed in the upper eyelid crease  and excess tissue is removed. Dissolvable sutures closed the incision in the crease line.
The lower eyelid surgery involves a trans-conjunctival approach to remove a portion of the 3  fatty deposits in the lower lids. if there is excess skin present, a pinch technique of the lower lids is performed and that incision was closed with tissue glue.
For many examples, please see the link below to our eyelid surgery  photo Gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

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What sort of procedures can I look into to significantly improve the appearance of my eyes?

+1
Hello Sean and thank you for your question.


My best advice to you for your concerns is sit face-to-face with a Plastic Surgeon(referred to as Board Certified in the US) and Here in Australia as 'Plastic and Reconstructive Surgeon'. We have many years of Specialist training and expertise behind us to help us help you.

A consultation gives the Plastic Surgeon the opportunity to properly assess what the problems are and what the options are to correct these. It also gives you the opportunity to show the Surgeon exactly what worries you and to discuss your expectations.
Then the two of you can discuss, and agree on, what process to follow, options and advantages and disadvantages of each, and you can the agree of how to proceed.

In short, I think you can definitely be helped. The surgery is always tailored to each person's specific anatomy and concerns. No amount of discussion on an online forum can replace the face-to-face consultation.

I wish you well.

Mark Edinburg, MBBCH, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 8 reviews

Droopy eyelids

+1
It looks like you could benefit from surgery to raise you upper eyelids, but you would need an in person consultation to determine which type of surgery might work best. You might also benefit from raising the outer corner or your eyes with a canthoplasty, but this depends on how much loose tissue is present.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 79 reviews

Ptosis

+1
You have a ptosis of both upper lids, so that your lids are covering the top part of you iris.  You also have some extra skin which adds to the heavy look of the lids. There is surgery to remove some of the skin, and tighten the muscle to elevate the lid.  The outer corner of you eyes is also too low.  This makes you whole eye appear tired, and to slant downwards.  Normally the outer corner of the eye should be a little higher than the inner. You can have the corner moved superiorly with a surgery which should help the eye have a more normal shape.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.