Leyla Arvas, MD

I understand how hollowness and wrinkles under the eyes can make you look tired or older than you feel. Based on your photo, it sounds like you’re dealing with a combination of volume loss (hollowness) and skin changes, which are common as we age, especially for someone with a slim facial structure like yours. Your Concerns:
Hollowness under the eyes is often caused by age-related fat loss in the under-eye area, which can create a sunken appearance. Wrinkles when smiling are likely dynamic wrinkles caused by muscle movement and skin laxity, which become more noticeable with age.
I recommended lower blepharoplasty and fat transfer. Lower blepheroplasty
is excellent for addressing excess skin, fine wrinkles, and mild puffiness under the eyes. However, if your primary concern is hollowness, a traditional lower blepharoplasty alone may not be sufficient. Instead, we can combine it with fat repositioning or fat transfer to restore volume. Fat transfer is a fantastic option to address hollowness under the eyes. We can harvest fat from another area of your body (e.g., abdomen or thighs) and inject it into the under-eye area to restore volume and create a smoother, more youthful contour. This is a long-lasting solution compared to fillers and can also improve skin quality.
And also temporal lift can help address mild sagging in the outer eye area and upper cheeks, which can indirectly improve the appearance of the under-eye area. It lifts and tightens the tissues, creating a more refreshed and harmonious look.
For your hollowness in the upper eyelids, we can use fat transfer to restore volume there as well. This creates a more balanced and youthful appearance.

As a plastic surgeon, I understand how facial asymmetry can affect both your appearance and your confidence. Based on your description, it seems like you’re dealing with a combination of structural asymmetry and age-related changes, which can make the imbalance more noticeable over time. The fatigue and tenseness you’re experiencing could also be related to muscle tension or compensatory mechanisms due to the asymmetry.

I recommend brow lift or forehead lift, would be an excellent option to address the asymmetry in your upper face, particularly if your right eyebrow and eye area appear deeper set or smaller. This procedure can elevate the brow, smooth out the forehead, and create a more balanced and youthful appearance. It can also help alleviate the tension or heaviness you’re feeling in the area.
Also, your forehead is wide, which can contribute to the overall imbalance in your facial proportions. A forehead reduction surgery (also known as hairline lowering surgery) could be a great option to reduce the height of your forehead and create a more harmonious facial balance. This procedure involves removing a strip of skin at the hairline and bringing it down to achieve a more proportionate appearance.

Since Botox helped raise your right eyebrow but didn’t fully address the “pushed back” appearance, it’s possible that you may benefit from additional procedures to achieve optimal symmetry. For example:

Fat Grafting or Dermal Fillers can add volume to the deeper-set areas of your face, restoring balance and contour. To determine the best course of action, I would recommend a thorough in-person evaluation.

While some of your concerns may be cosmetic, the fatigue and tenseness you’re experiencing suggest there may be functional aspects to address as well. A brow lift or forehead lift, combined with a forehead reduction, could provide both aesthetic and functional benefits. However, it’s important to tailor the treatment plan to your unique anatomy and goals.

Due to the procedures you have previously undergone, sagging has developed in your breasts. The gold standard treatment for this sagging is breast lift and implant surgery. However, if you do not want implants or scars, the most natural option would be fat transfer to the breasts, done in two sessions.

Hi, thank you for your question. Both High-Intensity Focused Ultrasound (HIFU) and Thermage are non-invasive cosmetic procedures used for skin tightening and rejuvenation. When it comes to pain, individual experiences can vary, and what one person finds tolerable may differ from another's perception. However, there are some general observations about the discomfort associated with each treatment:
HIFU uses ultrasound energy to target specific layers of the skin, stimulating collagen production and tightening the tissues. During the procedure, you may experience sensations of heat and prickling as the ultrasound energy is delivered. Some individuals may find HIFU uncomfortable, particularly in more sensitive areas or if higher energy levels are used. However, most patients report the discomfort as manageable and tolerate the procedure well.
Thermage: Thermage employs radiofrequency energy to heat the deeper layers of the skin, promoting collagen remodeling and tightening. During the treatment, you may feel a heating sensation along with intermittent cooling bursts to protect the skin's surface. The level of discomfort experienced during Thermage is typically described as mild to moderate, with some patients reporting a brief, pinching or stinging sensation when the radiofrequency energy is applied.
It's important to note that both procedures aim to be as comfortable as possible for patients. Most practitioners take measures to minimize discomfort, such as applying topical numbing creams before the treatment or adjusting energy levels based on individual sensitivity.
It is better to have a consultation with a professional before deside which procedure is suitable for you.

Hi, Thermage is a non-invasive cosmetic procedure that uses radiofrequency energy to tighten and stimulate collagen production in the skin. It is commonly used to treat various signs of aging, including forehead lines and wrinkles. While Thermage primarily targets the deeper layers of the skin to promote collagen remodeling and tightening, it is not typically associated with significant loss of volume in the face. The procedure mainly affects the skin's structure and does not directly impact the underlying fat or other facial tissues responsible for volume. In some cases, patients may experience mild swelling or temporary tightening of the skin immediately after Thermage. This effect can sometimes create a perceived reduction in volume, but it is usually transient and resolves within a few days or weeks.