Roger P. Friedenthal, MD

From your pictures, you appear to be a very good candidate for what is called a tip rhinoplasty. Your nose is quite beautiful except for the distortion at the tip. It is not clear from photos, of course, exactly which cartilages need reshaping, but you can leave the bone alone. Good luck.

You are quite correct that a graft such as Alloderm or hard palate can be required in complex situations where the lower lid is scarred and shortened after surgery and where the lower lid can not easily be lifted with your finger. Sometimes skin grafting can be required. Usually, however, mild lower lid retraction is due to tissue relaxation rather than tissue shortening, and the condition is very responsive to tightening the lower eyelid with a canthopexy. To help determine whether you are a candidate for a canthopexy, try this test. Feel with your finger where the outer corner of your eye is. Now feel next to that the inner part of the bone of the eye socket just to the side of the corner of your eye. Ideally the corner of your eye is connected to the bone. If you can feel a distance between the corner of the eye and the bone, you are probably a good candidate to have a suture placed to reattach the structures together. That is what is called a "canthopexy" in medical terms, shortening the stretched out ligament that holds the lower eyelid to the bone. Speak with your surgeon--or another surgeon if you wish--about having your problem corrected. It will hopefully be very straightforward.

I believe that you would be a very good candidate for an injectable deep facial filler such as Voluma. It would give you some cheek bone fullness immediately and is also reversible if you do not like the effect. An experienced dermatologist is certainly qualified to perform this procedure. Sculptra is also a possible filler that would be effective if properly done, but it does take several injections over time and is not reversible. Good luck.

While there are some instances in which cheeks can really be too full, I would recommend caution regarding any fat reduction in the cheeks at a young age. One of the biggest problems we have with facial aging is the loss of cheek volume and the appearance of hollowing. Reducing cheek fat in borderline circumstances can result in early facial aging later on. Stick with their being cute, and hold off on any procedure-at least at this time.

I must agree with Dr. Ishoo that you need to have your own personal consultation with some qualified plastic surgeons so that you can make your own decision. You have a lifetime of experience in making choices based on your intuition from personal interactions, and this is your most reliable source of information.  Ask to see pictures, do not be fixed on laser vs. skin excision, and ask about whether you need canthopexies or not. Good luck on you investigation.