Upper eyelift type and undereye wrinkles/bags/dark circles treatment? (Photos)

I am a 40-year-old Korean female interested in an eye lift. 1. Photo #1 is what my eyes look like normally, without smiling. I am interested in an eye lift of the upper eyelids so they look closer to Photo #2. One surgeon recommended a traditional blepharoplasty. The other recommended a brow lift. Which one is right? 2: Photo #3 is when I'm smiling. Do I need plastic surgery to minimize the undereye wrinkles/bags/dark circles? Or is there another option?

Doctor Answers 4

Eyelid surgery may open up your eyes and get the eye shape you want better than a brow lift, while looking more natural

Thank you for your question. You are a 40-year-old Korean female, and submitted several photos: first photo at rest, second with your eyebrows raised, and the third smiling or with a facial expression. You’ve gone to a couple of doctors, and you have desire to look like photo number 2. One doctor recommended eyelid surgery, the other doctor recommended brow lift so you want to know which is correct. You also ask about the under eye area.

I can give my impression based on the photos you submitted and your question, and help you distinguish what to expect with either of these procedures. A little background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I specialize in Asian eyelid surgery among other things, and this type of question comes up a lot.

What appears to be the situation when you show photo number 2 is you like the shape of the eyes when your eyebrows are raised. If you look at the first photo, the eyelid skin is a little hooded, and that shape dominates the appearance of the eyes. When you raised your eyebrows, the shape of the skin that’s overlapping shifts upwards, so the eye shape has a different appearance.

That said, I would ask first if you want your eyebrows higher? From my perspective, your eyebrows are at a natural position and where they should be. I would respectfully disagree with the colleague who recommends the eyebrow lift because it is my feeling that eyebrow lifts are often done too aggressively, and results in people with normal eyebrows looking like they’re perpetually surprised. Now that’s an aesthetic judgement and aesthetic style.

If your goal is to really have that shape of your eyes, then it is somewhat achievable with eyelid surgery. This means you and the prospective doctor have to agree on how much skin you leave behind to get that shape. What I routinely with patients considering Asian eyelid surgery is use an instrument like a Q Tip to fold the skin inward to show what the shape would look like. It is not uncommon for people to want to have a conservative result with just a little eyelid showing, with lot of people want a well-defined double eyelid, and some want a more subtle eyelid. I think that if that is the goal, then you could probably achieve it with eyelid surgery. When it comes to Asian eyelid surgery, the decision point is often based on the desired outcome, and the presence or absence of excess skin and fat.

Generally, with someone who has a fair amount of skin but wants a conservative approach, I can perform a non-incisional Asian blepharoplasty where little openings are made in the skin, but skin is not removed. The skin is anchored to the muscle called the levator muscle so the skin folds at a higher place. I suspect now the skin doesn’t really fold, but rolls passively and goes on top of the eyelashes, which dominates the shape of the eyes. If that skin was fixated a little higher, it would probably reveal the shape of photo number 2.

The other option is, if there is excess skin, is an excisional or an incisional type of blepharoplasty where an incision is made and some skin is removed. Typically, it’s very conservative so no more than a few millimeters. If there is any fat, which it doesn’t look like you have, then fat can be addressed at the same time.

For the lower eyelids are concerned, when you look at photo number one, there appears to be fat pockets that are pushing forward. In a situation like that, with your skin type, I generally do a transconjunctival blepharoplasty where I go from the inside of the eyelid to reduce the fat pockets causing puffiness.

To address to address skin quality, which is part of what you are dealing with when you show photo number 3 where your skin is folding has some lines. There are a couple of ways to address that. One is to address the activity of the muscle which causes those lines called orbicularis oculi muscle. That’s a muscle around the eyes that contracts when you smile and causes these lines often referred to as crow’s feet. We treat that with Botox™ to relax those muscles. We improve skin quality with a combination of platelet-rich plasma (PRP) which is derived from your own blood and used to stimulate the collagen. Basically, the goal is to improve the backbone of the skin, or the dermis, so the skin doesn’t wrinkle as much. Understand you’ll always have some wrinkling when you smile as it’s very natural and appropriate, but to prevent the lines from being too deep, especially at rest which we refer to as static lines, a program of Botox™ and skin quality improvement is an option. In addition, there are thermal energy based devices that help tighten the skin. For someone with Asian skin, I go towards the radiofrequency treatments such as Pelleve to help tighten the skin, but that is dependent on the importance of these concerns.

I think it’s important you have this discussion with your doctor, and look at yourself with your eyebrows raised. If you focus not only on the shape of the eyes, but at the shape and appearance of the whole facial expression, I think you won’t want your eyebrows that high up. If you do, then you should certainly move forward with the brow lift but I think you’ll probably be better off with the upper eyelid surgery, and possibly lower eyelid surgery. I hope that was helpful, I wish you the best of luck and thank you for your question.

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New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

You don't need a brow lift but you do need a little crease.

You don't need a brow lift but you do need a little crease.   I think an anchoring technique Asian eyelid surgery would do well for the upper eyelids along with skin removal. If you want the appearance to be very natural the way you have simulated it to Crease needs to be very close to the eye lash line.  For the lower eyelids hard to tell from your photos but you might benefit simply from Botox and filler or a conservative lower eyelid blepharoplasty may be good for you.  Chase Lay MD  Asian eyelid surgery specialist 

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 72 reviews

Upper lid Blepheroplasty

Based on the pictures posted, your eye brows are in good position and needs no brow lift.You seem possibly to have droopy upper eye lid and need ophthalmology evaluation for eye lid ptosis.Lower lids need nothing, unless the photos do not show the herniated fat. That needs in person examination.In general you need in person examination by a Plastic Surgeon and Ophthalmologist  complete examination.Then a proper plan can be discussed with you.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Blepharoplasty vs Brow Lift

In general, although brow lift does lift the upper eyelid skin to some extent, it's primary goal is to lift the eyebrow position and rejuvenate the forehead. On the other hand, upper blepharoplasty is done to address the issues related to the changes that occur due to aging. In my opinion, your desired outcome is probably best achieved with traditional blepharoplasty. With regard to your lower eyelid, since your main issue is the bagginess due to excess fat, and dark circles, the best option, in my opinion, would be lower blepharoplasty.

Eric In Choe, MD
New York Plastic Surgeon
4.6 out of 5 stars 49 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.