Matthew Bridges, MD, FACS

I actually think you need more volume in your upper lids, not less. I have no idea what the "sausage" look is. I would definitely not suggest excising muscle. Typically a bit of fat from the compartment just over from your nose can be trimmed, but conservatively. Fat grafting or filler just under the upper orbital rim would be a very nice addition to the procedure. I actually think you really need a temporal browlift as well. The excess skin around the outer corner of the eye is more from drooping of the brow than from the lid. This would be something to discuss with your surgeon.

The nose is all about proportion. In your case the tip may be proportionally more projected than the bridge. To fix the proportion the tip can be brought back or the bridge can be projected out. I would actually consider augmenting your bridge as a consideration. Deprojecting the tip, depending on how it's done, could result in changes in the tip shape, or flaring of the nostrils, that you might not like. I would definitely have computer morphong done with an experienced rhinoplasty surgeon to go over options. I don't really like filler in the nose. The only way filler could help would be to raise the bright height, but it complicates things if you ever wanted to have rhinoplasty for a permanent fix. Good luck

Thanks for your question. The answer is probably both. I think most patients who need blepharoplasty would probably benefit from at least a temporal browlift. That said, I do think you would have an nice result from blepharoplasty alone. I probably wouldn't recommend just a browlift, however. Dr. B

I don't know if I'm missing something but you have beautiful eyes. I can't imagine that you could make them better. Make sure you understand the complications if someone offers surgery. It's pretty easy to create asymmetry.

I don't like Mersilene mesh at all. The tissue grows into it, making it very difficult to remove if needed. Solid silicone is easy to remove if needed. Mersiline is very inflammatory as well, whereas silicone is essentially inert. By the way, from your photos I agree that you need a very small implant, if anything. I would actually say you might benefit more from an "anterior" neck lift, meaning it a neck reshaping done via an incision under the chin (and sometimes with small access incisions around the earlobe). This would increase the apparent distance from your chin to the turning point of your neck by improving the definition. My 2 cents...

I do think you might consider a temporal browlift. It's a great procedure. I actually think most patients who come in for upper blepharoplasty probably need a browlift more than blepharoplasty.

Anything that can be done open can be done closed. Period. I would suggest not getting bogged down in the details of the surgical maneuvers. You should continue to look for a surgeon who can provide morphed photos you like. However... If there's 1 thing that gives rhinoplasty surgeons cold feet it's patients who are too particular about the morphed images. At some point you have to trust the surgeon's judgement. Make sure your expectations are not too high. Find a surgeon who you like who has good before and afters and go for it!

You should see a surgeon who does computer morphing. We do it routinely for all rhinoplasty patients. It really helps make sure everyone is on the same page and set expectations. However, make sure you see before and after patients to know that the surgeon can deliver actual results.

I would say you could definitely have a nice change, but just maybe not quite like the photo. You should go see a good Rhinoplasty surgeon who does computer morphing so you can get a realistic idea what is possible.

This is a very unusual plan. First, it's odd not to do browlift with upper blepharoplasty, since the amount of browlift achieved will affect how much skin can be safely removed from the upper lids. Also, you still still be bruised and swollen at 10 days, so going back under anesthesia at that point is probably not wise.