I look tired and angry. Hate the dark circles, hollow eyes and sagging brows. Are my eyelids a problem too? Advice? (photo)

Doctor Answers 5

Less than ideal photograph.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
You have bilateral upper eyelid ptosis with compensatory eyebrow elevation.  I recommend seeing an oculoplastic surgeon to be assessed for ptosis.  Do not get fillers to the subbrow area.  In my opinion that will not at all help you.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
newD, lighting is bad (sorry) and nothing beats a 3D live evaluation but you may want to consider botox as a start. Should you consider surgery make sure you see an experienced specialist that does "only faces" and is familiar with the concept of a segmental release of the brow. For the lower lids, which I cannot see at all,  I prefer a 
"SOOF lift blepharoplasty". Search the Internet for further information. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Mild ptosis

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Based on you photos, you may have a mild ptosis - left more than right. This often presents with a tired appearance, edge of the lid/ lid margin dropping down closer to the pupil, and a hollowing in the upper lids. When the levator is reattached to its normal insertion, it may advance the normal orbital fat with it and fill in the hollow to some extent. Your brows appear to be above the superior orbital rim - a good level. Surgically raising the brows can make the hollow in the upper lid more pronounced, so my opinion would be to focus on elevating the eyelid margin by advancing or reattaching the levator. The brows/ forehead would relax, but your relaxed position in the first photograph shows good brow position. Oculoplastic surgeons are most experienced with the levator muscle - so I would lean you in that direction.Dark circles may be related to allergies, and/ or eye-rubbing. If that is a problem, then using allergy medications - oral or topical drops, cool compresses with a soft clean cloth, and avoiding hand-to-eye contact and rubbing will help. A more aggressive option is CO2 laser resurfacing of the periocular skin. This eliminates fine wrinkles and induces collagen giving a smoother more "plump" look to the skin. The CO2 laser resurfacing can also be used to tighten and smooth the forehead area giving a fresh appearance to the skin. Best wishes on your decisions.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 12 reviews

Eyelid surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello and thank you for your question. Based on your photograph, you are a great candidate blepharoplasty.  This can be performed with no visible scars.  The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 173 reviews

Eye issues

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I can only answer based upon the photos. Your upper eyelids look hollow and do not look like they need treatment.  Hard to say about lowers in photos. If you have tear trough depressions. fillers might be the way to go.You need to be evaluated in person.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.