Jill Foster, MD

The medial and central portion of your lower eyelid look like the position does not need adjustment to achieve what you show in your modified photo. Your natural photo shows some downward dystopia of your lateral lower eyelid ( the half toward your ear). I agree that a canthoplasty alone might not create a natural result. Placing a spacer graft in the lateral half of your lower eyelid (on the back side of the lid) to push the lid up, perhaps in conjunction with a mild canthoplasty, might be able to create the upward movement of the lateral half of your lower eyelid that it appears you are wishing to modify.

Vertical wrinkles between the eyebrows are sometimes diminished during browlift surgery when the surgeon teases the muscles in this location to diminish the effect on the overlying skin. These muscles pull the eyebrows down and weakening them may be useful. Horizontal wrinkles across the forehead are less likely to be diminished by brow lifting because they are created by the muscles that elevate the brow that the surgeon will want to keep working after surgery to keep the brows up. If your wrinkles are mild, using a neurotoxin might be a better solution than surgery.

On the photo, the eyelid on the left side of the photo looks open more than average. There is white showing above your cornea. This would not fall into the range of normal eyelid position. On the lid on the right side of the photo the folding of the skin is more noticeable and the lid is at a lower height than the left. If this difference in lid position is new compared to your old photos, even if your blood tests for thyroid disorder were normal, I would be concerned that you could have an underlying autoimmune thyroid dysfunction. This can happen even with normal thyroid screening blood tests. Before you have surgery, your surgeon may want to test for immune thyroid blood tests like TSI. If you have euythroid thyroid eye disease, it may change the plan for surgery.

These would be great questions to pose to your reconstructive oculoplastic surgeon, and perhaps you already have. For the defect you had from the skin cancer, your current result looks excellent, but it is reasonable to inquire as to whether there could be options for the things that you are noticing. Part of the answer depends on how long ago you had surgery. The defect in the skin from the cancer removal has caused some tightening of the eyelid skin below the eyelid margin that is rolling the margin away from the eye in the area of the cancer removal. If the surgery was in the last few months, even if you did nothing, you will still get improvement in the tightness of the tissue and the position of the margin and the bumpiness you notice. Thin or dilute soft tissue filler in very small amounts can be used as a "tissue stretcher" in the lower eyelid for a small amount of lid retraction. Sometimes this is combined with medications such as 5FU or steroids to modify wound healing. If it has been longer than a year, this may not be as helpful and then you have to consider whether surgery to try to release the skin along the margin leaving an open area to heal with upward traction on the eyelid like a tarsorrhaphy stitch for a week could help, or consider a tiny skin graft. This might help the eyelid roll back up and in, but the cosmetic results of a skin graft are not always predictable, and you could end up with something that you like less than what is there right now.
The other issue that alters the appearance of the lid is some lash loss. The absent lashes that were necessary to remove as part of the cancer surgery create a highlight along the lid margin that adds to the perception that more eyelid is showing. Using makeup to camouflage the lash loss would help, or you could consider some delicate tattooing in just that area.

In reviewing your photos, if you are female, the existing natural contour of your brow would better fit an aesthetic ideal than the contour you drew in.   The medial modification you made makes the brow too flat for a female brow contour.  That said, if you are a male, the changes you have demonstrated make sense, and neurotoxins are a good tool for altering brow contour.