Maryam Nazemzadeh, MD

In your pictures, you appear to have a combination of under eye darkness and hollowness. For the hollowness, I recommend treatment with fillers. Depending on how much of the pigmentation remains/bothers you after filler treatment (since fillers can improve some degree of the dark appearance), I would then potentially recommend treatment of the pigmentation with topical creams and microneedling. 

Your pictures demonstrate mild dermatochalasis (hooding of the upper eyelid skin) and lash ptosis (eyelashes directed downward). This can be corrected with a blepharoplasty with or without lash ptosis correction. When looking for a surgeon to possibly perform your surgery, it's important to see a trained oculofacial plastic surgeon. Asian eyelids present specific challenges and if done by an inexperienced surgeon, your results can be undesirable. 

Please consult with your prescribing ophthalmologist, however there should be no interaction between the aminoglycoside eye drops and your Dysport injections. 

In some patients the glabellar lines are so deep that simple relaxation with neurotoxins (Botox, Dysport, Xeomin) is not efficient. If these cases, a combination of neurotoxin and filler may be useful to get the desired effect. It's important to keep in mind that zinc deficiency can cause neurotoxins to be ineffective. Also, repeated injections of neurotoxins in a short period of time can cause antibody production that can also cause the neurotoxin to be ineffective. In these patients, I ask them to take a break from neurotoxins for 6 months before they receive further treatments. 

Aggressive removal of skin with blepharoplasty can result in lagophthalmos, or an inability to close your eyes. This can lead to detrimental effects to your corneal health and to your vision. For this reason, only a certain amount of skin can be removed during a blepharoplasty procedure. I do agree that your eyebrows are ptotic or droopy and you could potentially benefit from a brow lift in the future. You can achieve a modest elevation in your brows with Botox. I agree with your surgeons recommendations. Also, remember, you can always go back and remove more skin if needed after a blepharoplasty, however, if too much skin is removed, it is much more difficult to repair or replace the damage that could be done.

What you are noticing is the forward prolapse of normal fat pads that sit in the lower eyelids. A lot of times this indeed is genetic. In your situation, you could either do filler or a lower eyelid blepharoplasty. Both are great options, however one is a more permanent fix (blepharoplasty) and the other will require maintenance on your end (will need filler every 9-12 months depending on the the filler that is used). The answer is truly a personal one. Some of my patients will first choose filler to see what they could potentially look like with surgery and then will go forward with surgery once the filler has absorbed. This buys you some time before surgery. Other patients don't want to deal with the maintenance of filler and choose to do the blepharoplasty. Again, the decision is yours and there is no wrong answer. 

The first thing to do is a complete eye exam with an ophthalmologist. If one eye appears to be protruding more than the other, it is important to rule out systemic disorders such as thyroid disease. It is also important to rule out (very rare), a possible lesion or mass in the orbit causing asymmetry. If this is ruled out, then it is possible to create more symmetry between your eyes. The first thing I notice is a more active orbicularis muscle around the left eye. This is a muscle that helps close your eyes and is more prominent around your left eye. A few injections of Botox can help relax this muscle and give you a more symmetric appearance. I would recommend seeing an ophthalmologist for a full eye examination and an oculoplastic surgeon to evaluate your eyelids. 

The lower eyelids sitting in a lower position can due to a number of reasons. I recommend seeing an oculoplastic surgeon to ensure that there are no secondary causes for your lower eyelid position. In addition, an oculoplastic surgeon can recommend a possible surgical intervention to raise the position of the lower eyelids. 

Thank you for your question. Yes, I highly recommend seeing a highly trained and qualified oculoplastic surgeon to perform your lower eyelid blepharoplasty. In my opinion, a doctor should only perform a surgery if he or she is able to manage the possible complications. When it comes to a lower eyelid blepharoplasty, I have seen complications from non-oculoplastic surgeons such as lower eyelid ectropion (eversion or sagging of the lower eyelid), abnormal contour of the lower eyelid, loss of the lateral canthal angle, lateral canthal rounding, severe dry eyes, and more. It is best to see an oculoplastic surgeon to minimize your risk of having such complications. You can also take a look at the web link for further information regarding a blepharoplasty procedure. 

First, ensure that you are not using any products on your eyelids (such as ointment that was prescribed post-operatively). If you are using any products, along your eyelids, this may be secondary to an allergic reaction. However, as you indicated, this may also represent poor scarring. In that event, I would see your doctor in the near future as he/she may want to do injections along the scar (with steroids/Kenalog and/or 5-fluorouracil) to minimize it's appearance. He or she may recommend placement of silicone gel, however I would wait for your doctor's approval prior to starting any products. In the event that the scarring is too extensive, your doctor may want to do a scar revision. Regardless, I would see your doctor earlier than your scheduled appointment in November.