David M. Mills, MD, FACS

Although the best advice would always tell you to ask the surgeon who did your surgery first, I see no reason why it would be any more risky now than at any other time to proceed with eyebrow tattooing.  Good luck, and congrats on your surgery.

I applaud you for sharing, especially about the eye.  This raises an important issue in terms of surgeon-selection.  ASOPRS-certified surgeons with cosmetic training are most likely going to be the best option for you.  Although you don't live in my area, I wound encourage you to seek and ASOPRS-certified Oculo-Facial Plastic, Reconstructive, and Cosmetic surgeon.  There are some excellent ones in the San Diego area.  The main reason I say this (not trying to advertise on this site, but this is a critical element in your particular case) is because as you and many of the replies have eluded to, Fat Transfer may be in your future.  Assessing your lower face shows a simple need for face lift and fillers (understandable why you'd opt for fat given the possible reactions to synethetics), to which I'd add consideration of CO2 laser resurfacing.  You'll have to do this in such a way as to avoid that warm southern california sunshine.  Any ways, in reality, the eyes is where the money is... studies have shown that observers spend the vast majority of their time assessing the periocular region when determining an unknown individual's age.  The prosthesis looks slightly deviated in the photos posted here.  If you've had it for many years, it may be time for orbital implant replacement to better center the implant.  That maneuvar alone may enhance the periocular appearance and prosthesis retention.  We do a lot of facial cosmetic procedures in an ophthalmic patients, and I suggest you at least consider this avenue before making a final decision.  We'd be happy to see you should you ever wanna visit some warmer water.  Thanks.

As a board-certified ophthalmologist, I can assure you that silicone is approved in every state for use during vitreoretinal surgeries such as retinal detachment repair.  Its has been around a very long time, and is very well-tolerated by the body.  Therefore, it doubles wonderfully as a dermal filler.  As a facial plastic surgeon, I can tell you that we have used it for years in the face with excellent results especially in the lips or areas where a softer feel is desired.  However, it also functions well to build structures, such as mounds on a chin (popular with our male patients looking for a little tougher look).  The price you paid is also what we charge per injection session and typically more than one is required as it is permanent.  Therefore, we under fill a bit and allow the body to surround it and add to the effect, adding more over time as needed.

Botox has an excellent safety record in terms of medical complications. The effect however, is designed to work in some areas and not others. Therefore, it's the experience and training of the injector that really leads to optimal results in terms of patient satisfaction. The number one concern seems to be eyelid drooping. In our practice, we boast ASOPRS-certification. This is the society of oculofacial plastic surgeons, that is surgeons who are double-trained in eye surgery and facial plastic surgery.

Therefore, the way that we use Botox around the eyes is extremely precise. There is a less-recognized issue of dry eyes following injection around the eyes. This, too is best evaluated by someone who understand the ocular surface, and we check all patients for dry eye findings and symptoms prior to injection. Other specialties are excellent at using Botox as well, but even if you choose to have a non-eye surgeon inject you, you may wish to have the eyes evaluated prior to injection to ensure the highest level of safety. This is the most beneficial advice I can offer in addition the excellent comments made by my colleagues.

The dissection and movement of the tissues required to elevate the forehead and eyebrows during endocopic brow lift surgery can cause dysfunction of the frontal branch of the facial nerve, which innervates the frontalis muscle. This would lead to decreased function of this muscle.

Fortunately, unless the nerve was actually severed during surgery (which is rare), its function should return over time, although it can actually take quite a while for some folks. For the most part, just hang in there, and you have a good chance of regaining some if not all function.