Arnold Zweig, MD (retired)

It is really difficult to tell from your pictures due to the angle (vs. one from directly from the front) as to whether your eyelids are "droopy" or not.  As one of the other doctors indicated, it may be that you have heavy eyelids (but no excess skin).  Sometimes when someone is described as having the "puppy" look or "bedroom eyes", there is a chance that the person may have a condition known as "ptosis" which is a loss of muscle tone or tension that keeps the upper eyelid in the correct position.  I think you are wise to want to avoid a surgical procedure if possible and my advise is to see a board certified occuplastic surgeon.  An occuplastic surgeon is trained to correct conditions such as ptosis and can typically make an aesthetic correction as well if needed. 
 

The wrinkles and creases that are accentuated when you smile are due to the movement of your cheeks "pushing" your skin upward towards the lower lid area. Botox injections in the lower eyelid area are very meticulous and it requires an injector who is skilled and has a done a number of injections in that area with positive results.  I do not recommend injecting Botox in the lower eyelid area as there is a risk that your lower eyelid could pull down leaving you with temporary scleral show (the white portion is visible) as well as dry eyes and this could actually make you appear older if this were to occur after the Botox was injected. 

 As for filler in this area, I routinely inject a hyaluronic filler such as Juvederm to plump up depressions in that area which occur from a loss of natural fat that a leaves a diagonal crease between the lower eyelid and top of the cheek.  My advice is to consult with a Board Certified Facial Plastic surgeon who can determine the best solution for your problem.  You can visit the American Academy of Facial Plastic and Reconstructive Surgery website (aafprs.org) to find one in your area. 

I am sorry that you have had difficulty achieving the result you wanted for your eyelids.  My first piece of advise is to allow your eyelid to completely heal before considering any more surgery.  There is only so much skin that can be removed from the eyelid and still allow you to completely close your eye without any side effects such as a dry eye.  Having three surgeries on the same lid within the span of two years seems rather extreme to me.  You did not indicate if the same surgeon has performed all three surgeries and I am going to assume that it is the same surgeon.  I would advise you to wait 6 months to a year before considering another revision.  Looking at your eyelid it appears to me that you have a condition known as "ptosis" which is a loss of muscle tone or tension that keeps the upper eyelid in the correct position and as you mention the eyelid "dropping" that may another indication that you do have this condition.  My advise is to seek the services of a board certified occuplastic surgeon when you are ready for the next revision.  An occuplastic surgeon is trained to correct conditions such as ptosis and can typically make an aesthetic correction as well.  

Based on your picture it does appear that your nose could be refined however the degree of improvement will depend on how thick the skin is as well as the amount of cartilage underneath the skin.  If the skin is relatively thick and there is very little cartilage to remove then the results will be a minimal change.  When you consult for possibly having this surgery, the surgeon will certainly take into account your unique facial features and make recommendations based on what you need to fit and enhance your face.

My advice is to consult with a Board Certified Facial Plastic Surgeon who will examine your nose to determine how much refinement can be achieved.  You can find a qualified surgeon in your area by visiting the website for the American Academy for Facial Plastic and Reconstructive Surgery (aafprs.org).  When choosing a surgeon you should be able to review before and after pictures of patients who had their surgery with this doctor and have the opportunity to speak with some of his/her patients.  Most surgeons also use video imaging to give you a concept of how you might look after the procedure. 

I agree with Dr. Laverson that the chance of you having "sagging" skin at 29 is most likely not truly loose skin unless your genetics (did your father or mother have a "turkey" neck at an early age?) are causing it.  If it is fat that you are seeing and making you unhappy then that can certainly be improved with liposuction and your skin should tighten up as you are young and your skin should have a great amount of elasticity. 

My advise is to consult with a Board Certified Facial Plastic Surgeon who will be able to tell you what your options are for improving this area.  Best of luck.