J. Renee Booth, MD

Rhinoplasty to sculpt the rounded nasal tip with reduction of the nasal alae would help bring the attention toward your eyes. Pyriform aperture augmentation would also be helpful. This can be done permanently with a graft during the rhinoplasty or temporarily with filler. This will help your upper lip on profile view become more vertical with less backward slant. It appears that there may be upper eyelid droop (called ptosis). It is hard to tell with photos alone. Seeing an Oculoplastic surgeon who can repair eyelid ptosis would allow a definitive diagnosis. If you have ptosis then correction will make you appear more awake and brighten the eyes. In the meantime, you could try Upneeq (generic oxymetazoline) eye drops to see if it is helpful.

The upper eyelid surgery is often used to create a crease or to remove extra skin. Some surgeons will also suspend brow tissue (using a "browpexy"). The edge of your brow that is further from your nose (lateral brow) appears to either have swelling or prominent tissue (sometimes this is due to the lacrimal gland and other times due to the brow fat pad). It is reasonable to use massage 3 times a day for about 1-2 minutes using something to help your fingers glide on the skin (such as Vitamin E oil or lotion). Start by the corner of the eye that is close to the nose and use a motion going upward + backward. If this does not help after 3 weeks, then it is reasonable to look into getting a browpexy.

One article on this is: The Brow Fat Pad Suspension Suture: Safety Profile and Clinical Observations by Dr. Eftekhari et al. published in the journal Ophthalmic Plastic Reconstructive Surgery in 2016.

Some people get nice results after having 3 sessions of radiofrequency microneedling. It can help with the puffiness, however the deep grooves between the lower eyelid and the cheek and along the cheek (palpebromalar and malar grooves) may persist. One of the most common and effective treatments to treat the grooves is fat grafting (requires harvesting fat). Another option is two to three sessions of platelet rich fibrin injection (requires a blood draw).

If the radiofrequency microneedling does not achieve the degree of improvement wanted, then a blepharoplasty surgery can address the fat pads under the eyes.

Yes, a rhinoplasty would be able to sculpt your nose to the desired shape. There are ways to refine both the bridge of the nose and the tip of the nose.

I recommend a combination of platelet rich fibrin which has your body's own growth factors to help with rejuvenation (this requires a blood draw). Also Radiofrequency microneedling or laser would be helpful to improve the skin quality. An alternative to platelet rich fibrin is nanofat, which has your body's own stem cells. This requires a procedure to harvest fat. Platelet rich fibrin and nanofat are not filler and do not increase volume directly. They help your body make its own collagen.

Of note, some people feel that firming creams are helpful, but they are not as reliable as the other options listed earlier.