Michael A. Burnstine, MD

Please look into the possibility of thyroid eye disease. The left upper eyelid retraction is concerning. A thyroid function test and a review of older photographs would be a major help.

You should have a thorough eye exam, including eyelid measurements. You have left greater than right upper eyelid ptosis (droopy eyelid) and dermatochalasis (excess skin). Addressing both will give you a spectacular result.

Before having additional surgery, I advice getting thyroid function tests. These include T3, T4, TSH, Thyroid Peroxides Antibody and Thyroid Stimulating Antibody. My concern is that you have thyroid eye disease. Comparing your current photograph to a driver's license or older photos will help to determine weather the right upper eyelid is retracted. It is critical to compare old photo eyelid position to your present photo.

It looks like your brows are raised too high and you have a small micro upper eyelid ptosis. I will first try Botox to the brows and Upper eyelid elevation ( ptosis repair). Together this will provide more upper eyelid fullness. If it is still hollow, augmentation with fat or filler will additionally help the hollowness.

I agree that your eyes are slightly wider apart than the norm. Having said that, I think you are a handsome guy and the risks of doing any intervention outweigh the benefits of bring the eyes close together. The intervention would require orbital surgery with bone movement and the risks would include loss of vision and double vision.

You are very perceptive. I agree with you that you have a residual problem. What looks like crepey excess skin in your photo is more likely volume loss. By adding volume to the sub-brow region, you will have a more youthful upper eyelid eyebrow complex. At present, you look hollow.

This can be a tricky problem. Understanding the relationship between the eyebrow, upper eyelid position, and skin and fat is critical. From your 13-year-old photo, it appears that you have developed progressive ptosis and volume loss. Eyelid elevation and filler placement to the eyebrow would created more youthful eyelid complex.

The photograph on the right looks like you have a small amount of upper eyelid ptosis. Ptosis repair and either fat transfer, repositioning, or filler augmentation would give you an elegant result. Good luck!

You have crow's feet from contraction of the orbicularis muscle. Neurotoxin will diminish the muscle contraction and resultant wrinkles.

The Botox can cause asymmetry, After 3 months, it should resolve any consequences. Any neurotoxin will be temporary. Your smile should return.