Although keloid formation would be unusual in the eyelids, if there is a personal or family history of keloid scarring, caution would be advised. That being said, I would like to raise a related consideration, namely the possibilty of sidestepping surgery altogether via the use of nonsurgical periorbital rejuvenation techniques. When we speak of rejuvenating the eye unit, we are talking about all the aesthetically important areas that surround the eyes, namely the upper and lower lids (including the upper cheek region immediately below the lower lids); the brows; the periorbital area to the sides of the eyes; and glabella area between the eyebrows. Today, happily, each of these regions may be improved nonsurgically (i.e. without cutting, stitches or prolonged healing and downtime. In this case, the problems appear to be heaviness of the brow region and flattening of the upper inner cheek and under eye regions and the development of tear troughs.I can only make some general comments about eye unit rejuvenation goals that can be achieved nonsurgically. For example, a few microdroplets of Botox or other neuromodulator (such as Dysport or Xeomin) placed in the glabella area would help to not only lift, but reposition the slight downturning seen there. Prominent flattening of the upper inner cheek areas can be improved significantly with the use of a volumizing filler, such as Juvederm UltraPlus XC (which will likely also have the secondary benefit of improving the regions directly below the eyes. The tear troughs and hollows of the lower eyelid can be addressed with injectable fillers--my preference here being Belotero Balance, since it is unlikely to give rise to the bluish discoloration, known as the Tyndall Effect, sometimes seen with other hyaluronic acid fillers when injected superficially or within the very delicate tissues around the eyes. Consultation with a board certified aesthetic core physician with extensive experience in nonsurgical eye rejuvenation techniques would be strongly advised so that a specific treatment plan can be formulated.