I think a mild ptosis repair on the right at the same time as a bilateral upper lid blepharoplasty is a good option. I likely would suggest fillers to the tear trough for now in order to make the puffiness of the lower lids less visible and wait until there is more loose skin on the lower lid to have surgery on that art.
upper and lower eyelid surgery
The photographs demonstrate ptosis in the right eye in the normal aging process of the upper and lower lids. To obtain coverage by medical insurance, medical necessity must be documented with visual field obstruction tests, pictures and complete chart notes from your eyelid surgeon. This is all submitted to insurance for preauthorization prior to the surgery. For many examples, please see the link below
You do have a ptosis of the upper eyelids, worse on the right. You also have extra skin which can be removed. In the photos, the brow height seems pretty good. In the lower lids you have prolapsed orbital fat and loose skin. You would benefit from a fat transpositioning blepharoplasty. See an oculoplastic surgeon to discuss these options.
Upper eyelid heaviness from 3 factors
You are correct in most of your observations. You do appear to have upper eyelid ptosis R>L, along with stretched upper eyelid skin and brow droopiness. Each requires a different procedure, which can be performed together. See an oculoplastic surgeon for evaluation.
What would be appropriate for these aging baggy eyelids?
Hello and thank you for the question. Upper eyelid skin excess could be from actual eyelid skin laxity or drooping of the brows (or both). Your eyebrows do seem a bit uneven in position which may be why you see more skin on the right upper lid than the left. It does not appear to me that you need a brow lift unless you recently had botox to the forehead which will raise the outer parts of your brow. Some people are candidates for insurance coverage but that depends on each individual plan. You would need an ophthalmologist to do a test called Visual Field Exam to see if the upper eyelid skin causes any difficulty with your vision.
Your lower lids seem to have some fat pads which could be corrected at the same time.
Fat loss to the temples is corrected with fat injections which also could be done to the creases where your lower eyelid meet your cheek. Adding volume helps rejuvenate the face, especially around the eyes.
You should seed some opinions from board-certified plastic or oculoplastic surgeons.
There are many things that can be done to give you a more alert youthful appearance and it will depend on your goals and interests. You would benefit from upper and lower lid lifts and fat repositioning and fat grafting. After this you would also benefit from a resurfacing procedure. You may want to also address the middle and lower third of your face and consider a full facelift and neck lift to have a harmonious result. Good Luck
Based soley on your photos I would be recommending a "SOOF lift blepharoplasty" and an endoscopic brow lift; most likely a 3/4 lift. The exact type of brow lift would depend on your exam. For the majority of my patients I do the upper lid bleph secondarily. Good luck!