Cameron Nabavi, MD, FACS

A great combination for upper lid rejuvenation would be an upper lid blepharoplasty and endoscopic brow lift. A lateral brow lift wouldn’t be a great option because there is also some droop of the inner brow. You can consider a blepharoplasty alone which will improve the area some but what you’re grabbing between your fingers is partially brow tissue that won’t lift without addressing the brow itself.

Another thing to consider for a refresh would be the lower lids. Puffiness there can be addressed with a hidden incision in the eyelid and possibly laser resurfacing to improve the tone and texture of the skin.

It is hard to tell from this photo but it seems more like fullness from eyelid skin hooding rather than ptosis. This asymmetry is likely due to some slight brow height and contour asymmetry. Depending on examination of the area, you can consider removing more skin from the more heavy side with a blepharoplasty. Silent sinus syndrome is possible, but unlikely, and can be assessed with formal examination. Typically, the eye looks more sunken in position and smaller which doesn't seem to be the case in the picture.

Upneeq can be a good indicator of whether internal ptosis repair will achieve the desired result. The formal test is using phenylephrine to assess the improvement of the eyelid. This can be done with your surgeon during consultation. I would imagine that you would be a good candidate, but I would want to test that first.

Your photos are very common to see in filler related swelling. Have you had filler anywhere in the cheeks or anywhere near this area? Any other product used anwhere even close to this area? I would try hyaluronidase injections in the area before considering blepharoplasty as what seems to be there is fluid and edema. Blepharoplasty helps bulging from fat and wouldn't have much of a role as far as I can see from these photos.

It is hard to assess fully without examination in person, but it is not uncommon to have more wrinkles after lower lid blepharoplasty with fat removal and/or transposition. Skin pinch with canthopexy or canthoplasty can help reduce wrinkles. Botox can also help reduce the dynamic wrinkling that comes with smiling. Also, laser resurfacing can as well depending on your skin type.