Edward Buckingham, MD

Hi there. From your photos, an upper bleph would be helpful to address the excess upper eyelid skin. You have deeper set eyes so I would be cautious to remove upper eyelid fat.

Hi there. From your photo, it is a bit difficult to tell, but it does look like there is some volume deficiency along your orbital groove, so fat transfer could help in this area.

Hi there. From your photos, it looks like you would benefit with a lower eyelid blepharoplasty and fat transfer to the orbital grooves/nasojugal groove. This would help with your "under eye bags" as it removes the puffiness and fills in the areas with volume deficiencies to improve the contour and shadows. In addition, you could consider lower eyelid skin rejuvenation which could be in the form of CO2 laser to the lower eyelids or a TCA peel to the lower eyelids. For Crow's feet, neuromodulator (ie: Botox) is recommended.

Yes. Botox is safe and affects the movement of your muscles, this does not affect your jaw. Similarly fillers are also safe as they are in the soft tissue planes and should not affect your bone.

Hi there, there are some areas of volume deficiencies shown in your photos. You could consider filler to this area as it's localized and targeted. I would not recommend biostimulatory fillers to this area. Also, as an alternative, you could consider fat transfer to this area.

Hi there. Yes, it can potentially make the hollowing more prominent if your surgeon performs fat removal with your upper bleph. Not every upper bleph involves fat removal, so this is something you should discuss with your surgeon.

Hi there. Depending on what kind of filler you had, you can consider dissolving the filler with ultrasound guided injection of hyaluronidase. Ultrasound can help show where the filler has migrated to.

Hi there. The indents and shadows you see are areas of facial volume deficiency. From the photo, it looks to involve the nasojugal groove and orbital groove. This can be improve with either facial fat grafting or with filler. Facial fat grafting should only be done if your weight remains stable, as fat grafting carries risk of fat hypertrophy if a patient were to gain weight (+10 lbs).

Hi there. From your photos, I can identify two areas to improve, the lower eyelid pseudofat herniation and the volume deficiency along your orbital groove and nasojugal groove. A transconjunctival lower eyelid blepharoplasty with fat grafting to soften the transition along nasojugal groove and orbital groove (tear trough and lower eyelids) will help with the dark shadows that you see. Regarding the "pigmentation", this is simply because the lower eyelid skin is very thin. This appearance will improve with fat grafting. You can also try to thicken the skin in this area by using skin care products that boost collagen.

Hi there. I would not recommend CO2 laser to treat mild upper eyelid hooding as this is not an indication. While CO2 helps with skin resurfacing and deep wrinkles, it will not meaningfully retract your upper eyelid skin to address your concern. One thing to take note of is that upper eyelid hooding can be potentially caused by brow descent, which can sometimes be subtle and involve just the lateral tail of the brow. There are various brow lift options that may be an alternative to an upper blepharoplasty that can treat the upper eyelid hooding, and in some cases, both brow lift and upper bleph procedures may be concurrently indicated.