Carol Boerner, MD

The feeling of tension in the 11s area after the first muscle relaxation may be due to the patients effort to focus her eyes. Those mildly farsighted gals unknowingly use the corregator muscle  to squint that little bit to sharpen their vision. I am a retired ophthalmologist so can verify this. Warning them of this potential feeling relieves some worry. And, obviously this lady needs a little more product temporally to lower her brow tails. 

I have a lot of experience treating dry eyes with systemic essential fatty acids. IMO, it is the omega3s, not the Omega 6s that make a difference. Flax has the omega 3s. Please consider using 3,000 mg of Barleans brand FLAX seed oil, TAKEN IN THE AM. This way it is best absorbed. If you have had your gall bladder removed, you must use OILSMART, a concoction of flax seed oil and the enzymes needed for you gallbladder less folk to absorb these essential fatty acids. 
Do you have RA? Treatment for autoimmune dry eyes may involve more complicated medications. 
Please let me know how you do. 

I recently treated a 60 year old lady with a congenital Bell's palsy. Nobody had ever offered to fix her crooked face. It broke my heart. I used fillers to balance her cheeks and Xeomin, another botulinum product, to fix the twitches and straighten her smile. She is a new person-she never stops smiling! So, your two year problem can certainly be treated! Good Luck!

 Acne scars can really hurt your self esteem. We stopped using fillers for acne scars and have had great success with micro needling. It seems to be a fairly permanent way of softening those scars, and is certainly more comfortable for you than injecting each scar. Please consider this option too. 

Retin-A is certainly the gold standard in skincare. I am glad you are starting in your 40s. Before you spend a lot on creams, please evaluate your supplements too. Consider taking 2000 mg of Barleans brand of high lignan flax seed oil every AM. Yes, AM is important. I suggest Barleans because IT WORKS -it has those phytoestrogens. All flax seed oils are not created equal. It is like lotion for your skin from the inside out. It also has other terrific health benefits-and it makes your nails and hair grow faster too. Astaxanthin is also great for your skin as are B vitamins. 
Don't forget to keep hydrated. Those 8 glasses of liquid a day can plump your skin. Please don't use those fake sugar drinks! Try a dash of flavored (cranberry is good) balsamic vinegar in icy water for a hydrating treat.
Then consult your cosmetic doctor to find the right products for you. I like the Teoxane product line because of the special Hyaluronic acid component that can make skin luminous. Please let me know if this helps.
Kindly, Dr.Carol