Board Certified Oral & Maxillofacial Surgeon
Dr. Pasha Mostofi, MD, DMD, FAACS, is a cosmetic surgeon at Pasha MD Cosmetic Surgery in Bellevue, WA, certified by the American Board of Cosmetic Surgery and the American Board of Facial Cosmetic Surgery. He completed a six-year oral and maxillofacial surgery
Asked By: Thrifty391739
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Yes, based on your photos and your description, surgery can often make a nose appear narrower and more defined from the front. One thing to keep in mind is that the goal is usually not to make the nose dramatically smaller, but rather to improve its shape, contours, and balance with the rest of your facial features. When a nose looks wide or "blobby" from the front, it is often because the tip lacks definition, the nostrils are broad, or the bridge and tip proportions make the nose appear wider than it actually is. From your photos, it appears that improving tip definition and possibly narrowing certain parts of the nose could help create a more refined appearance. In some cases, reducing nostril width can also contribute to a slimmer look. The exact approach depends on your underlying anatomy, including your cartilage strength, skin thickness, and facial proportions. It's also important to remember that a nose that is made too small can look unnatural or out of balance, especially when viewed from different angles. A consultation with an experienced rhinoplasty surgeon would allow a detailed examination and, in many cases, computer imaging to show realistic possibilities. The best results come from creating a nose that fits your face rather than simply making it as small as possible. Based on your concerns, I do think there are likely surgical options that could make your nose appear less wide and more defined while still looking natural. Hope this helps!
Asked By: Reliable55818
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Based on your photo, you do appear to have some mild upper eyelid drooping (ptosis), especially with a higher-than-average eyelid crease. This combination is actually pretty common. A ptosis repair could help lift the eyelids to a more open and balanced position, and in many cases it can also soften or lower the appearance of a very high crease. However, ptosis surgery alone may not fully “make the eyes smaller.” What it really does is improve eyelid position and shape so the eyes look more refreshed and symmetrical. In some patients, combining ptosis repair with a conservative upper eyelid blepharoplasty or crease adjustment gives the most natural result, especially if the goal is to reduce the hollow or deep-set appearance of the upper lids. The key is being careful not to overcorrect, since that can make the eyes look too round or overly open. An in-person exam is important because your surgeon will measure eyelid strength, symmetry, brow position, and how much skin is contributing to the look of heaviness or crease height. Overall though, you do look like someone who could benefit from a subtle ptosis correction with attention to crease shape for a softer, more natural appearance.
Asked By: Prometheus123
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Yes, a SOOF lift can often still be performed even if you have filler in the under-eye and cheek area, but whether the filler should be dissolved first really depends on the type, amount, and placement of the filler. In many cases, filler can make it harder for the surgeon to accurately assess your natural anatomy and tissue position, especially around the under-eyes where even small amounts can blur the true contour. If the filler is subtle and looks natural, some surgeons may leave it alone. However, if there is a lot of filler, puffiness, or migration, dissolving it beforehand usually leads to a cleaner and more predictable result. Personally, I’m not a huge fan of relying heavily on facial fillers long term because they can sometimes mask the real structural issue rather than correct it. In select patients, I prefer facial fat grafting because it can look softer and more natural. A SOOF lift is designed to elevate the deep cheek tissues and improve the transition between the lower eyelid and cheek. The movement is generally more upward than sideways when performed thoughtfully. In fact, a vertical lift is usually the goal because it restores a more youthful position to the midface without creating an overly “pulled” appearance. The amount of lift varies from person to person, but it is typically subtle and natural-looking rather than dramatic. The best candidates are patients with early midface descent, hollowing, or heaviness beneath the eyes who want restoration instead of simply adding more volume with filler. An in-person evaluation is important because the decision to keep or dissolve filler really depends on how your tissues look underneath it.
Asked By: Johnshoe118
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Hi there. You actually have a fairly common under-eye appearance for someone in their 40s, and I don’t think anything looks “severe” here. What I do notice is more of a hollowing and shadowing issue rather than significant puffiness or excess skin. In cases like yours, a lower blepharoplasty alone often does not dramatically improve the area unless there are obvious fat bags to reposition or remove. In fact, if too much volume is removed surgically in someone who is already somewhat hollow, it can occasionally make the under-eye area look more skeletonized or tired. I can also understand why the cheek filler may have made things look worse to you on one side. Fillers placed too heavily or in the wrong plane can sometimes accentuate the transition between the cheek and lower eyelid rather than soften it. Personally, I’m not a huge fan of relying on fillers for this area long term, especially in thinner patients or men, because they can create puffiness, unevenness, or a slightly artificial look over time. If you ever decided to treat this area, I think you’d likely benefit more from subtle volume restoration with conservative fat grafting rather than additional filler. Fat grafting can soften the hollow in a more natural way when done carefully. That said, based on these photos alone, I honestly don’t think surgery is necessary unless the under-eyes really bother you in everyday life. You still have a natural and masculine under-eye contour, and sometimes chasing complete smoothness around the eyes can lead to an overdone appearance that looks less natural than where you started. Hope this helps!
Asked By: Courageous681981
ANSWER
Hi there. Congratulations on your weight loss, that is a huge accomplishment, and it’s very common for the face and eye area to change afterward. Looking at your photos, I do think you would likely benefit from a cosmetic procedure, but based on what I see, this appears to be more of an upper eyelid hollowing and mild brow asymmetry issue rather than a true heavy brow problem. Your brows are sitting fairly well overall, although one side is naturally a little lower, which many people have. The upper eyelids themselves look somewhat hollow and deflated after the weight loss, which can make the eyes appear more tired and accentuate asymmetry. Because of that, I would be cautious about a traditional upper blepharoplasty alone. Removing too much skin or fullness in someone who already has hollow upper lids can sometimes make the eyes look more sunken. In your case, a conservative approach is important. Depending on your goals, options could include subtle upper blepharoplasty combined with volume restoration (such as fat transfer), or possibly a small temporal brow lift if the lower brow side bothers you most. Sometimes a little Botox brow balancing can even help preview what a lift might accomplish before surgery. The good news is that you have nice eye shape and skin quality, so even small refinements could make a meaningful difference while still looking natural. An in-person exam would help determine how much of the asymmetry comes from the brow position versus the eyelid itself, but you are absolutely a reasonable candidate to explore treatment at this point. Hope this helps!
Asked By: Imaginative2481
ANSWER
Congratulations on your weight loss, that is a major accomplishment. What you are seeing around the eyes is very common after significant weight loss, especially in the late 40s when the skin naturally becomes thinner and loses elasticity. From your photos, I see a combination of under-eye hollowing, mild looseness of the lower eyelid skin, and some descent of the cheek tissues. Because of that, filler alone is probably not the best solution. In patients with thinner skin and crepey texture, filler can sometimes make the area look puffy, uneven, or even more noticeable over time. I think you would benefit more from a treatment plan that restores support rather than simply “filling a groove.” One option I often prefer in cases like yours is conservative fat grafting to the under-eye and upper cheek area. Fat tends to look softer and more natural in patients who have lost facial volume after weight loss. That can be combined with skin-tightening or resurfacing treatments to improve the crepey texture and fine lines. You may also be a candidate for a lower blepharoplasty, but not necessarily the old-fashioned “skin pulling” type. The best results usually come from carefully blending the lid-cheek junction while preserving a natural appearance. In many patients your age, the issue is not excess fat, it is loss of support and volume. The good news is that your concerns are very treatable, and I do not think you look “too old” for your age at all. You simply have the volume changes and skin thinning that often follow major weight loss. A thoughtful combination approach will usually give a much more refreshed and natural result than filler alone. Hope that helps!
Asked By: Intellectual441753
ANSWER
Hi there. Malar mounds can be one of the more frustrating areas around the eyes and upper cheeks because they are often caused by a combination of swelling, weakened tissue support, fluid retention, and changes in the skin itself, not just “loose skin.” That is why a facelift alone sometimes does not improve them significantly, even when the rest of the face looks rejuvenated. Based on your photo and history, direct excision can be effective in carefully selected patients, especially when the fullness is more fixed and prominent, but it does come with the tradeoff of a visible scar risk in a very delicate area of the face. Other options that are sometimes considered include lower eyelid tightening procedures, laser resurfacing, chemical peels, or treatments aimed at reducing chronic swelling, though results can be variable and often incomplete. In some patients, filler can actually worsen the appearance, so caution is important there. The most important step is determining whether the mound is primarily fluid, skin laxity, fat, or scar-related tissue from aging and prior surgery, because treatment success depends heavily on matching the procedure to the underlying cause. I would strongly recommend consultation with a facial plastic/cosmetic surgeon or oculoplastic surgeon who has extensive experience specifically treating malar mounds, as this is a very specialized problem and one of the more challenging areas in facial rejuvenation. Hope this helps!
Asked By: Gregarious670292
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Hi there! I can understand why you are confused, all three surgeons are looking at the same area but focusing on different ways to treat it. After looking at your photos and reading your concerns carefully, I actually think your instincts are important here: your main issue is not really excess puffiness or “bags,” but the deep hollow that creates the shadow under the eyes. In your case, I would personally lean away from fillers as a long-term solution, especially because you are young, thin-skinned, and already have a naturally delicate lower eyelid area. While filler can sometimes soften a tear trough temporarily, this area is notorious for swelling, unevenness, and that slightly puffy or artificial look over time, even when injected well. Some patients love it initially but end up chasing maintenance or dissolving it later. I also understand the hesitation about fat grafting. Fat transfer can work beautifully in the right patient, but under-eye skin is extremely thin, and fat survival can be somewhat unpredictable. Small irregularities that might not matter elsewhere on the face become very noticeable in the tear trough area. That does not mean fat grafting is “wrong,” but it does require a very experienced surgeon and very conservative technique. Based on your photos, I actually think Surgeon #1’s approach makes the most anatomical sense if surgery is truly needed. You do appear to have a tear trough hollow that is related to the transition between the lower eyelid fat and the upper cheek. In those situations, carefully repositioning a small amount of your own existing fat can create a smoother contour because it addresses the actual structural change instead of simply “filling” on top of it. The key is conservative, precise surgery, not aggressive fat removal. That said, I would also tell you not to rush into anything. Your under-eyes are not severe, and because you already like the natural character of your eyes, you want to preserve that. In someone like you, over-treatment is a bigger risk than under-treatment. If you decide to proceed, I would prioritize a surgeon who specializes specifically in lower eyelid surgery and consistently produces very natural results in younger patients. You are asking exactly the right questions, and honestly, there is not one universally “correct” answer here, there are simply different philosophies. But if your goal is the most natural and durable improvement to the hollow itself, I would personally favor a conservative structural approach over repeated filler treatments. Hope that helps!
Asked By: Cheerful471796
ANSWER
Hi there. You sound like exactly the kind of person who often does very well with a facelift - healthy, fit, and wanting your outer appearance to better reflect how youthful you feel. Based on your photos, I can see some natural age-related changes like mild sagging along the jawline, some looseness in the neck, and softening around the cheeks. These are all areas a well-done facelift is specifically designed to improve in a natural, refreshed way rather than making you look “tight” or overdone. Being slim and healthy actually works in your favor, because your skin quality and healing ability tend to be better, and the results can look more refined. The goal wouldn’t be to change how you look, but to restore the definition you likely had years ago, especially along the jawline and neck. As for cost, it varies quite a bit depending on your location and the surgeon’s experience, but most patients in the U.S. can expect somewhere in the range of about $15,000 to $30,000 for a facelift. That usually includes surgeon fees, anesthesia, and facility costs. Sometimes, small add-ons like eyelid surgery or skin treatments are recommended to get a more balanced result, which can affect pricing. The most important next step is an in-person consultation with a qualified surgeon. They can assess your skin, facial structure, and goals in detail and recommend whether a full facelift, a smaller “mini” lift, or even a combination approach would suit you best. Overall, from what you’ve shared, you seem like a strong candidate, and with the right surgeon, you can expect a natural, refreshed version of yourself rather than a dramatic change.
Asked By: Neat250414
ANSWER
Hi there. At 28, a true facelift is almost never the right first step, and based on what you’ve shared and your photo, your concern looks more like early volume imbalance and mild tissue descent rather than significant skin laxity. A facelift is designed for more advanced sagging and excess skin, which you simply don’t appear to have. In your case, adding more filler, especially in the lower face, can sometimes make the area look heavier rather than lifted, which may be part of why you’re not loving your results so far. What tends to work better at your stage is a more strategic, subtle approach. That could mean either dissolving and reassessing the current filler if it feels overdone, or shifting focus to restoring support higher in the face (temples, upper cheeks) rather than chasing folds directly. Fillers aren’t always the best long-term solution, this is where fat grafting can be a really nice, natural alternative in the right patient, as it restores volume in a softer, more integrated way. You might also benefit from non-surgical tightening treatments or small tweaks like neuromodulators (ie. Botox, Dysport, Xeomin, etc) around the lower face to improve the pull of certain muscles. The key is balance, not more volume. If you were sitting in my office, I’d recommend stepping back, possibly dissolving what’s there, and rebuilding in a more conservative, structural way, rather than jumping to surgery. Hope this helps!
Dr. Pasha Mostofi is highly regarded for his expertise in a wide range of cosmetic procedures, including , , , , , , , , , , , , and . Patients consistently praise his skill, attention to detail, and compassionate bedside manner. His ability to make patients feel comfortable and confident in their decisions is a common theme in the reviews.
