Mihail Climov, MD

Based on your photos and everything you've described, I would approach this conservatively — focusing on skin removal only. You don't appear to have significant fat fullness in the upper lids, and I would be very cautious about removing any additional fat or muscle to avoid creating the hollowed look you're rightfully concerned about.

Thank you for reaching out, and I completely understand how frustrating it can be to look tired no matter what you do — under-eye hollowness is one of the most common concerns I see, and it can absolutely be addressed.Just to clarify one thing: a brow lift addresses the forehead and upper eyelid area, so that wouldn't target your concern. What you're describing — the hollowness and shadow under the eyes — falls in the territory of the lower eyelid and tear trough area.At 20, the most likely cause is a natural fat pad prominence or malpositioning combined with a deep tear trough — meaning the fat that sits under the eye is either casting a shadow or has a hollow beneath it. This is very common and absolutely treatable at your age.The most appropriate options to consider would be:Tear trough filler — A great starting point at your age. Minimal downtime, natural results, and completely reversible. This is often all that's needed in younger patientsLower blepharoplasty with fat repositioning — A more permanent surgical solution where the fat pad is repositioned to fill the hollow rather than removed. In the right candidate this gives a beautifully long-lasting resultHope it helps!

Thank you so much for reaching out and sharing your experience. This is actually a very common question, and I'm glad you asked it.First, the good news: your result is genuinely much improved from where you started, and your surgeon did an excellent job. Removing 15mm of excess upper eyelid skin is a meaningful correction, and the improvement you saw in those early months reflects exactly what the surgery was designed to achieve.Here's what's important to understand about upper blepharoplasty and skin quality over time: Blepharoplasty removes excess skin — it addresses the volume and overhang of redundant tissue. What it cannot permanently alter is the intrinsic quality of the skin itself. Upper eyelid skin is the thinnest skin on the entire body, and over time, the natural loss of collagen, elastin, and hydration that comes with aging causes that fine wrinkling and crepey texture to gradually return. This is biology, not a surgical shortcoming. When tissue is healing and mildly swollen, the skin is essentially being "plumped" from within — so those first several months often look beautifully smooth. As the swelling fully resolves over 6–12 months, the skin's true underlying texture becomes more visible again. What you're noticing is the skin itself, not a loss of the surgical result. It's worth noting that a conservative, well-measured excision is actually a sign of excellent surgical judgment. Over-resection of upper eyelid skin can lead to an inability to fully close the eye — a condition called lagophthalmos — or outward pulling of the lower lid called ectropion, both of which can cause serious dry eye problems and corneal exposure. The fact that your result looks natural and your eye closes properly means your surgeon prioritized your long-term eye health, which is exactly right. For the wrinkly/crepey skin texture specifically, there are some options worth discussing: -Topical retinoids applied carefully around (not directly on) the eyelid can improve skin texture over time-Resurfacing treatments such as fractional laser or radiofrequency microneedling can meaningfully tighten and smooth eyelid skin without surgery-Neurotoxin (Botox) placed strategically around the periorbital area can soften fine lines-Medical-grade skincare with peptides and growth factors supports collagen maintenance The surgical correction you had is holding — what you're managing now is skin quality, which is an ongoing process rather than a one-time fix. You're in a much better place than you were before surgery, and there are good non-surgical tools to help maintain and refine that result.

Hello, and thank you for sharing your concerns. I understand how distressing it can feel when you notice changes in your face that seem to happen quickly, especially at a young age. Although you mentioned no weight loss, body composition changes can affect our faces, as rapid weight loss can. Both can sometimes lead to facial volume loss and changes in skin support that may make folds and sagging appear more noticeable. At 26, I typically do not recommend a facelift. Facelift surgery is designed to address structural aging that usually occurs later in life. In younger patients, we usually focus on restoring volume and stimulating collagen rather than surgically lifting the tissues. After a thotough evaluation, potentially labs and making sure your hormones are optimal, for someone your age, several non-surgical options may provide a much more appropriate and natural solution: Strategic dermal fillers to restore lost facial volume and soften nasolabial folds or marionette lines• Facial threads, which can provide support of the midface and brows• Collagen-stimulating treatments such as Sculptra, which gradually rebuild your own collagen and improve facial structure over time, potentially some energy devices. However, optimizing nutrition, particularly adequate protein intake, which plays an important role in maintaining skin quality and facial tissue support, in many cases, a combination approach works best to restore youthful contours while keeping the face natural. The most important step would be a thorough in-person consultation, during which we can evaluate your facial structure, skin quality, and areas of volume loss. From there, we can design a plan tailored specifically to you. You are very young, and with the right approach, we can usually achieve beautiful, natural rejuvenation without surgery.

For some people, a weight change of 5 to 7 pounds is insignificant, while for others, it can feel significant. This depends on factors such as your overall weight and whether you tend to store fat in the breast area. Based on my experience with the patient population I serve, a change of 5 to 7 pounds is generally not considered substantial.

Thank you for sharing your photos! The breasts are quite symmetric but exhibit upper pole deficiency. I would recommend an "anchor type" breast lift with minimal reduction. After the lift, depending on your satisfaction with the results, you might consider a small implant to enhance the upper pole and achieve a perkier appearance. However, most patients are typically happy with the results after the lift alone.

The need for a breast lift primarily depends on the degree of sagging of the breast tissue. In cases where the sagging is mild and the implant size is sufficiently large, it's possible for the implants to compensate for some of the sagging, but this situation is quite uncommon. Generally, if there is noticeable sagging, a breast lift is usually required.

Thank you for sharing your photos. When I analyze your anatomical left breast (which is on the right side of the image), I notice that the fold is much lower than the contralateral side. I don't have your initial photo, but it seems possible that the implant has descended. Additionally, the left breast appears larger. Did you receive implants of the same size? Was there any significant asymmetry between your breasts? Have you developed a fluid collection on the left side? Answering these questions is important. I also observe that the position of the left nipple is more lateral than desired. I recommend addressing the fold first, matching the size of both breasts, and then considering whether it's necessary to move the left nipple more medially. I hope this information helps. Good luck!

Hi, and thank you for sharing your photo. Obviously, I trust your surgeon's evaluation in person; however, based on the photo and ptosis (breast drooping), I can appreciate that you might also need a breast lift, especially if you are looking for a "perky" look. Good luck.

Thank you for sharing your photo. I am noticing asymmetry of the breasts, a difference of ~50-150 cc between the breast and bilateral ptosis: nipple to the fold distance appears longer. Based on the photos, you seem to be an ideal candidate for augmentation mastopexy (implant and lift); the implant will give you upper pole fullness; it is easier to correct asymmetry with lift on one side and lift/reduction on the larger side; this approach would give you a longer-lasting result. For augmentation only, you will require significantly larger implants, which is not impossible; it is impractical in the long term. A consultation is needed to emphasize your goals, perform the measurements, and discuss the options.