Trying to Decide Between Madonna Eye Lift or Blepharoplasty? (photo)

Your posted photos show some brow drooping, excess upper eyelid skin hanging down on to the upper eyelid lashes on forward gaze, deep tear troughs and palpebromalar grooves, moderate nasolabial folds, loss of facial fat around the cheek bones and early jowling from descent of the remaining cheek soft tissue. The neck cannot be assessed from your posted photos.`Fractal laser will not affect tissues deep to the skin so it alone cannot improve most of what I have described and it certainly cannot shrink all of the upper eyelid excess skin.

Your best option depends on how aggressively you want to go. Fat grafting around the cheek bones and blepharoplasty of all 4 eyelids is one way to go or you could go the route of facelift and blepharoplasty of the 4 eyelids. You definitely have more advanced facial aging than would be expected so stopping smoking, sunscreen etc. are important in your case.

If a visual field test shows obstruction of the upper visual fields your health insurance may cover the upper eyelid blepharoplasties.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

In your case surgery is best.

It can difficult to decide between the many surgical and non-surgical rejuvenations options available.  Eyes are the first place to show signs of aging and therefore the reason patients first come to a plastic surgeon’s office. 
The cause of an aged appearance to the eyes can vary.  Textural changes of the skin can be addresses with lasers to tighten the skin and improve the skin surface.  The other cause is contour irregularities from weakening of the tissues and support structures that hold the deeper fat pockets in place. 
In your case you have very nice skin.  While a laser can provide some further improvement in skin texture and tightness, it will not provide the rejuvenation that you are seeking.
I would recommend an upper eyelid blepharoplasty removing a small amount of skin to show more of the upper eyelid.   For the lower eyelids a conservative fat excision and fat repositioning with fat transfer would be best for you.   The fat transfer will place volume into the areas of shadows of the face and eyes creating an overall smoother contour and rejuvenated appearance.

 

Based upon the posted photos in my opinion only surgery will improve the appearance of the eyes and face.