To make a quality assessment, we need quality information. Look at how plastic surgeons take before and after pictures to get an idea. We’re basically looking for mugshots with pictures taken at correct angles, showing the front and profile. From the pictures even included, I see no strong indication for surgical intervention. The list of treatment options to create a more desirable or useful appearance is almost endless. Catering to women wanting to look younger is an almost infinite industry.For those who’ve never had any type of intervention, I would say often middle-aged women begin by having Botox and or fillers as the first entry to improving facial aesthetics. Whether the treatment is temporary or permanent, I cannot over, emphasize the importance of always looking for the most skilled and experienced providers. Provider selection is critical in maintaining an obtaining consistent high-quality patient satisfaction, whether the treatment is done in the office or operating room. Find the right provider is not at all easy or straightforward. I generally recommend patients consider consulting or interviewing with as many providers as possible before selecting the right provider for their needs. Expect to get a lot of different recommendations. This includes different recommendations based on what each provider has in their toolbox. If you consult with the nurse who does fillers and Botox, then they most likely not going to recommend lower eyelid blepharoplasty surgery. They may tell you that fillers is the way to go. If you talk to an oculoplastic surgeon, then they may recommend lower eyelid surgery or they may recommend fillers or a combination of both. Each providers background will create some inherent biases towards the recommended treatments. I generally recommend patients start by consulting with providers that have the skill and ability to offer the most comprehensive and involves treatments, regardless of what you end up choosing. Recognize that most plastic surgeons do average work. But their average work is acceptable to you or not is another question. If you’re looking for someone who does exceptional work, you’ll need to find an exceptional provider. I find it interesting that everybody wants an exceptional outcome, but so few patients are willing to put in the effort to find the best providers in their community. Personally, I don’t think you can find the best providers by using your cell phone or computer. In my opinion, it requires having in person consultations. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who have similar facial characteristics or areas of concern. Bring pictures of your face taken the same way plastic surgeons take before, and after pictures to use as reference. Don’t rely and memory or looking in the mirror to remember what you look like. Much of this type of work can be costly and there’s money to be made for those involved in this industry. Greed is a real thing so make sure you look out for number one. Best, Mats Hagstrom MD