Best Oculoplastic Surgeon in Florida.
Thank you for your question. You're absolutely right about needing an experienced oculoplastic surgeon to treat this delicate area.
Under eye wrinkles
It is difficult to make a recommendation without seeing you in person but the "bunching" and lines that seem to be present in the photograph are related to the muscle that closes the eye. In some people this muscle becomes enlarged which can create wrinkles when one smiles. This can sometimes be treated with fillers and botulinum toxins but it's a very delicate area and these are off label treatments. In certain patients laser treatment can be effective. You're absolutely right about needing an experienced oculoplastic surgeon to treat this delicate area. When it comes to doctors in Florida, I would recommend seeing John Martin or Wendy Lee.
Thank you for your question. It is helpful to hear your history related to the eyelids. The "pinch" technique to which you refer occurs when calipers are used to engage the amount of excess skin contained in the upper eyelid. The skin is then removed and the excess fatty tissue from the middle of the eyelid is also removed. In some cases, the upper eyelid muscle may be contoured as well.
In terms of selecting a facial plastic surgeon, I recommend that you consider single/double board certified surgeons and compare them based upon their education/training, years of experience, specialty, number of blepharoplasties performed, patient testimonials, and before and after photos. After using this criteria to limit their selection to a few surgeons, patients find it helpful to consult with a few different surgeons to compare prices and their personal rapport with the surgeon.
Eyelid bunching when smiling
Thank you for sharing your question. The best surgeon to see you is a doctor who refuses surgery. You will likely have a complication if you operate at this point. Careful injection of Botox into the orbicularis muscle and proper injection of fillers can make a substantial difference. See an experienced eyelid specialist for detailed evaluation. Good luck,
There is no best surgeon.
The best surgeon will advocate for you and not necessarily offer you surgery. Surgery will not accomplish what your are looking for which is elimination of skin heaping when you smile. Unless your eyelid is immobilize by motor nerve injury after lower blepharoplasty (which can happen) you will continue to be able to heap up that eyelid skin irrespective of the procedure perform. For that reason, the punishment should fit the crime. In your case, Under eye filler performed by a highly experienced injector is all you need at this time. Less is more. Don't talk yourself into a surgery that you do not need.
Best Oculoplastic Surgeon in Florida?
In my opinion, based on your photos, this does not require a surgical solution. At rest, you do not exhibit skin excess. Therefore a "skin pinch" blepharoplasty to alleviate the fine crepey wrinkling that is bothersome to you when you see yourself smiling would place you at risk for ectropion, as Dr. Kapadia described below.
Micro-droplets of Botox in the lower lids can help relax the action of the muscle that is causing the "bunching" when you smile. Additionally, a dermal filler such as Restylane Silk can help smooth the "tear troughs" that you have at rest. See my profile page photos for some patients who had similar presentations and obtained pleasing results with dermal fillers.
Best wishes! Harry V. Wright MD, Sarasota, Florida
Loose skin under eyes
Based on your photos and age, I would not recommend removing skin under your eyes. I do not see a lot of extra skin when you are at rest (not smiling). You need enough extra skin under your eyes so the eyelid does not get pulled down when the skin is stretched out, such as when opening your mouth or looking upward. I also worry that removing skin in your thirties may cause problems down the line. As we age, the soft tissues in the cheeks drop down, causing additional downward pull on the lower eyelids. Making the skin really tight in your 30s will not leave you any reserve for when you are in your 50s and 60s and may lead to ectropion of your lower eyelids later, even if this doesnt occur right away.
When we smile, the cheeks move upward, which almost always causes some wrinkling of the skin under the eyes. I think your eyes look beautiful and youthful and would recommend leaving them alone.