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. 

I used to perform dry eye tests on all my patients, and stopped doing so many years ago because the results had no real bearing on whether or not a patient would have dry eye symptoms after surgery. Instead I now ask a thorough history about dry eyes or other ocular symptoms or problems. If patients had prolonged dry eye issues following LASIK or have difficulty wearing contact lenses they may be at higher risk for symptomatic dry eyes post-operatively. I modify my surgery for patients with truly sever dry eyes, but dry eyes alone are not a reason to avoid surgery.

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.