Andrea Nowonty Hass, MD

Eyelid space depends on a number of factors, some of which include the position of the brow tissue above the lids, the space of the eye socket, how close the eyeball sits to the brow bones, and the amount of skin on the lids themselves. When the brow sits low along the orbital bones, a brow lift can open up the space for the upper lids. An endoscopic brow lift can give a modest lift, whereas a more traditional approach such as a coronal or anterior hairline approach can be more aggressive. As for achieving 'rounder' eyes, that would depend on the natural shape of your eyes and would not be affected by a brow lift. Consultation with a surgeon who performs all types of brow lifts should be able to give you a good idea for what a brow lift can do for you. 

In general, you do not have to wait until Botox wears off prior to having eyelid surgery. However, make sure that your surgeon is aware that you've had Botox recently and that your brows may be lower than normal as a result of the injections.

While I don't know your age, nor can see you in 3-dimension as I would in person, it looks like you are young and your skin and lids are rather youthful without a lot of excess skin. You may benefit from a trans-conjunctival blepharoplasty where the fat is removed from inside the eyelid. This surgery works well in young people who still have good skin tone. If you do chose to go for fillers around the eyes, research your doctor very carefully. Fillers around the eyes are too often overdone, giving the whole area a puffy appearance. Less is more. 

It is not unusual for patients to notice puffiness under their eyes after cataract or LASIK surgery. Depending on the type of anesthesia used (re local numbing), or the drops used, some puffiness can be related to the surgery and if so should resolve. However, since Mom's puffiness is under both eyes, and the cataract surgery was performed on one eye, it is most likely that the bags were present prior to surgery. With her improved vision she is now seeing things she had not noticed as clearly prior to surgery.

Once Mom has healed from her surgery, she can consider lower lid blepharoplasty to remove the eyelid bags. Talk to her ophthalmologist for a recommendation for a surgeon they trust for lower lid surgery.

I allow my patients to try soft contact lenses as soon as 6-7 days following surgery. I encourage gas-permeable lens wearers to wait a little longer unless they can remove the lenses without tugging on the corner of the eye. This does not mean patients chose to wear the lenses so soon!  The lids will feel funny - both numb and sensitive - for a few months after surgery and so may the lenses. Also - very important - I remind all patients before surgery to make sure they have current prescription glasses and sunglasses to avoid rushing back into lenses.

Because of swelling and bruising, it is not unusual to see some early scleral show that resolves readily with time. 1st - address your concerns with your surgeon - he/she may discuss somoe options with you.

I will often instruct my pateints to do what I call 'eyelid pushups' several times a day starting about 10 days after surgey and continuing for up to a month. While looking in the mirror, gently place a ring finger on the lower lid very close to the lashes. Without bunching the skin, give a gentle stretch toward the eyebrow and hold for 3 seconds and release. You will likely see an immediate improvement in lid position that will drop again. However, each time you do this you will be slowly improving the lid position untill you no longer need to do so (as determined when you no longer see a drop)

You can have surgery on hollow lower lids if there is excess skin or distinct fat bulges. It is very important that you see a surgeon who has lots of experience on lower lid surgery and can discuss exactly what you are looking for and where potential problems may exist. I generally do not recommend trying to correct lower lid hollows with fillers unless the hollow area is overlying bone.

Extremely rare, but a droopy lid can happen follwing injections of Dysport, Botox, or Xeomin. All three products work by temporarily paralyzing the muscles into which they are injected. Since they all work the same way, one brand will not undo the results of another. Sometimes Iopidine drops (prescription only) can help a litte. The good news is that the effect will wear off in the eyelid sooner than in the brow, so you should typically see improvement in your lids in about 4-6 weeks.

There are a number of reasons why you may be seeing wrinkles around your lips that you had not noticed when you started getting fillers in them. 1st of all, if I do the 'math' it sounds like you started getting them injected about 2 to 2 1/2 years ago. In that time you have gotten a little older, and some lines in the lip body may be normal for you. Also, over this period you've paid closer attention to your lips than you probably did before the 1st injection. My advice - give it some time so the lips can readjust. You can always get them re-filled if you can't stand it, but perhaps you want to fill less than before and slowly 'wean' yourself off the fillers. Beware of permanent fillers in the lips - remember Permanent Fillers can mean Permanent Problems. I would also caution you against any procedure that leaves a scar around your lips or mouth.