Anna Bakeman, MD

The pronounced under-eye hollows come from a combination of volume loss in the tear trough area protrusion of the orbital fat through the orbital septum which causes the bags you are seeing. Filler to the tear trough area can temporarily mask the hollowing, but for a longer lasting result this is best treated by lower blepharoplasty with fat grafting. This approach allows removal or repositioning of the fat that is causing the bags, restores lost volume with your own fat, smooths the lid–cheek transition for a natural look, and provides long-lasting results. Non-surgical options like additional filler or skin treatments may offer subtle improvement, but they don't address the underlying problem and carry the risk of looking unnatural

Generally if surgeons can work around the extensions with the understanding that some of the extensions could potentially get displaced during surgery. There are multiple approaches to lower lid surgery (through the skin or under the lid itself), so depending on the type of surgery you are having it's best to confirm with your surgeon in case they have specific preferences

You have prominent lower lateral cartilage at the tip of your nose, but the rest of your nasal structure looks excellent. During a consultation, you’d want to discuss your specific cosmetic goals with your surgeon. In your case, surgery would likely involve reshaping the nasal tip using small cartilage grafts to create a more refined contour. If you haven’t had prior nasal surgery, it’s very likely that the necessary cartilage could be harvested from your nasal septum rather than requiring rib cartilage.

Absolutely—we see this frequently. Nasal obstruction and difficulty breathing through the nose can stem from anatomic issues, inflammatory congestion, or a combination of both. Based on your photos, it appears you have significant anatomic narrowing of the nasal airway, which would likely benefit from straightening both the septum and the external nasal structure. A CT scan can help determine whether there is any underlying chronic sinus inflammation. This would clarify whether sinus surgery might be beneficial in conjunction with nasal airway surgery. Regardless, surgery to correct a deviated septum and external nasal deviation is typically covered by insurance, as it addresses functional breathing issues. These procedures are most often performed by a facial plastic surgeon. Some patients choose to combine functional surgery with cosmetic refinements, which would involve an additional fee—but this is entirely optional! If sinus surgery is indicated, some facial plastic surgeons are comfortable performing both components, while others may collaborate with a rhinologist or ENT colleague for the sinus portion.

Problems breathing through the nose can be inflammatory (ie allergies, chronic sinus disease) or structural in nature. Based on your brief description it sounds likely that nasal structure is at least playing a role. Even in the absence of a deviated septum, there can be problems with blockage of the front of the nose (called the nasal valve), and your description suggests something called a tension nose deformity, where the cartilage of the septum grows excessively and can lead to overprojection of the nasal tip and often associated nasal obstruction. Photos would help confirm this and you would benefit from meeting with a surgeon who focuses on rhinoplasty to have a full exam.