Sean W. Delaney, MD

Thank you for your question. There are two primary approaches to lower eyelid surgery. The transconjunctival method uses a small incision on the inside of the lower eyelid, so there are no external incisions. This approach is well suited for individuals who need fat removal or fat repositioning without lower eyelid skin excision. The subciliary approach uses a small incision immediately below the eyelash that extends slightly onto the crows feet region. This technique is better suited for patients who also require removal of excess skin or lower eyelid tightening, in addition to fat removal or repositioning. Alternatively, hyaluronic acid filler injections can be used to temporarily camouflage the eyelid bags and can be a good option for those who do not wish to have surgery. An in-person examination is essential to determine whether you would be a good candidate for the transconjunctival blepharoplasty. Both facial plastic and oculoplastic surgeons should be able to perform lower blepharoplasty proficiently. Make sure your surgeon is board certified, has good before and after photographs, and is someone with whom you feel comfortable.

The Tyndall effect describes a phenomenon in which light scatters when transmitted through a clear suspension, giving off a bluish hue. In this case, hyaluronic acid fillers (a clear suspension) placed superficially within the skin could potentially scatter light and appear blue. Such changes are not permanent. If identified, the superficial filler can be dissolved using hyaluronidase. Alternatively, one can simply wait for the filler to reabsorb. For tear trough injections it is essential to wait a few weeks to ensure that the color change you are seeing is indeed the Tyndall effect and not a bruise, which should gradually improve over the course of the first week after injection. It is difficult to tell from your photo the potential source of your lower eyelid discoloration. If the color change persists, I suggest following up with your injector for a further evaluation.

In certain individuals, large masseter muscles can contribute to the appearance of a square jaw. Botox injected into the Masseter muscle can temporarily weaken parts of the Masseter to cause it to shrink in size and make the jawline appear slimmer. As with any muscle, it takes a while for the muscle to start shrinking after it has been paralyzed. Botox usually begins to work ~ 3 days after injection, and it can take up to 2 weeks for the full effect of the Botox to take place.  The final effect of the Botox will depend on how large your masseter muscles are and how many units of Botox were used. At 1 week after injection, it is normal not to see a drastic change yet.  In instances like this, I would recommend waiting another week, and if you still do not notice an improvement in your jawline then you should visit your injector to see if you would benefit from more Botox.

Hi Doug. You may want to consider CO2 laser skin resurfacing to improve the appearance of your scar.

It is hard to determine what has happened with your left eyelid without photographs. In general, Botox begins working 2-3 days after injection and reaches its peak effect by 2 weeks. If you are noticing changes around the eye 2 days after injection, it may take several weeks before you see an improvement. In some instances, Botox injected near the eyebrow can spread to temporarily weaken the levator muscle that is responsible for pulling up on the upper eyelid and cause the eyelid to droop. Alternatively, injections too close to the eyebrow can cause the eyebrow to droop. Fortunately, Botox is not permanent and this issues usually resolves in 3-4 months. In the meanwhile, Apraclonidine eye drops can be used to help raise the affected eyelid until the Botox wears off. Be sure to see your injector to discuss your concerns.