Earl Gage, MD, FACS

In the photo you posted, it doesn’t appear that you have excessive lower eyelid skin or abnormal folds. The wrinkles that concern you are pretty normal. You may be able to improve and tighten the lid a little with a lower eyelid blepharoplasty, but attempts to be too aggressive in lid tightening can result in a lower lid that is too tight and may not close properly. Conservative lower lid blepharoplasty with some fat repositioning rather than aggressive lid tightening is probably best if you are committed to surgery. You will want to ask how often your surgeon does lid surgery, ask to see some photos before and after and clarify what type of incisions your surgeon will use. Make sure you also discuss the potential complications of eyelid surgery. Best of luck!

Without knowing more details about he ridge you mention, this is a hard question to answer. It is true that scars that are firm and raised (ridged?) typically soften and smooth over time. This process is often called scar maturation and may take a year or longer. Sometimes scars that remain hard can be improved by other treatments such as steroid injection or laser treatment.

It is also true that scars can widen, particularly if there is a lot of tension from a tight surgical closure. Most experienced plastic surgeons are good at avoiding undue tension in facelift surgery to avoid scar widening.

You may want to clarify what your plastic surgeon meant at your next visit. I'm glad you area happy with your overall result!

At 4 weeks post surgery, most of your swelling has likely resolved. However, there still may be some swelling. Be patient. Also, the scars are still maturing and softening. You should not judge your outcome based on how things look this early after surgery. I can't tell how much hollowing you have, and the lighting in the photos is different enough that it's hard to tell how dark the circles are beneath your eyes. However, remember that poor hydration, stress, and poor sleep can all make dark circles beneath the eyes worse. Start with the easy fixes of healthy eating, improved sleep and improved hydration. If the problems with hollowing and dark circles persist, they adding some volume back may be needed.  You should continue to discuss with your plastic surgeon as your result evolves.

It looks as though you have developed ectropion. Massage and time may help this resolve. Sometimes it can take weeks to perhaps even months for scars to soften and for the lid to become softer. If your current regimen of massage and taping doesn't work, then additional surgery may be needed to tighten the lid and maybe even release some of the scar. Be patient, though. It is still early.

Having a little extra skin and an upper eyelid crease is normal. Only when that folded skin becomes excessive and the eyes have a more droopy, tired appearance should you consider surgery. You probably still have a number of years before eyelid surgery would be beneficial for you.