I need advice for droopy face and eyelids? (photos)

I am 38 and a non smoker. I live in NYC but willing to travel. I have been wanting a rhinoplasty but now that I have aged quite a lot for a 38 year old I believe I need an upper blepharoplasty and the longest lasting possible filler under my eyes (Bellafill?). I have had Juvederm and Restylane under my eyes in 2010/ lasted 3-4 months. I am interested in restoring the fat loss on my face. Any treatment suggestions would be greatly appreciated as well as an approximate cost for both procedures.

Doctor Answers 13

Nonsurgical Cheek Augmentation Can Secondarily Improve The Under Eye Area & The Smile Lines

From the photos provided, it appears that there is significant volume loss in the cheeks that has secondarily led to the formation of the tear troughs, etc. under the eyes and to the prominence of the smile lines. Before embarking on anything else, it would seem reasonable to address the volume loss in the upper cheekbone and mid cheek regions and then assess the secondary benefits to the under eye region and to the nasolabial region. Voluma XC and Radiesse Plus would be my choices for these purposes in my Upper East Side Manhattan practice. (In my Israel satellite facility, where a far greater number of regulatory agency approved volumizers are available, would be Stylage XXL and Emervel Volume). There is usually little to no downtime and the results of treatment typically prompt an immediate "Wow!" response 

Following this, you might benefit from a couple of microdroplets of Botox under each eye and possibly (depending upon the outcome of the above) the use of Beletero Balance (NY) or Teosyal Redensity II (Israel) to further improve the under eye region. I would absolutely NOT consider using a permanent filler, such as Bellafil, as permanent fillers mean the possibility of permanent dissatisfaction (if the result is not pleasing) or short and long-term (even decades later) problems if they occur. 

As to the upper lids, I would leave this to the end, since the improvements from the above may be so striking that you might no longer be troubled as much by that problem. In the meantime, you might also check out The Ten Minute Eyelift, which is a minimally invasive approach to treating this region. I would also wait on treating the nose, since this region, too, may appear improved simply by improving the surrounding cheeks.

There is no need to travel for treatment. What is important that you seek consultation and treatment by a board certified, aesthetic physician and be sure to ask to see his/her before and after photos before agreeing to proceed. Best of luck to you.

New York Dermatologic Surgeon
4.8 out of 5 stars 22 reviews

Rhinoplasty and eyelid surgery combination

A rhinoplasty procedure can accomplish narrowing the bulbous tip and refining it, along with narrowing   The bridge line and decreasing the overall projection of the nose.  An upper blepharoplasty procedure can accomplish removal of hooded and excess skin in the upper lids to rejuvenate them,  in addition to a small amount of fat removal as well. For many  before and after results of rhinoplasty and eyelid surgery, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Facial rejuvenation

Hello and thank you for your question. You may benefit from upper and lower eyelid blepharoplasty and voluma or fat grafting for your midface.  Malar implants are also an option.  Based on your photograph, you may also benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement.    Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 67 reviews

Face and eye issues

It looks like you might benefit from a conservative upper and lower bleh and maybe facial fillers/fat for volume as necessary. Best to see in person for a proper evaluation.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

I need advice for droopy face and eyelids?

Thank you for your questions.  If you were pleased with the initial results of filler injections then fat grafting to the tear trough area and cheeks would be the next option.  An upper blepharoplasty can be done at the same time.  The wrinkling with smiling are dynamic lines and the outer one third of the crows feet can be treated with Botox. You might also benefit possibly from a trans-conjunctival lower blepharoplasty although an examination in person is necessary for that decision.

Nose and eyes

An upper lid blepharoplasty would correct the lid ptosis. This is a simple procedure which can be performed in an office based surgical facility.  In terms of the lower lids/cheeks, to restore volume, filler is indicated.  That area has thin skin which is why the heavier fillers are not best.  I like the new Restylane Lift a great deal. It's also important to assess the volume of fillers when evaluating the duration of the treatment.  Under treatment will not produce a long lasting outcome and there is a definite trade off in terms of cost as well. Technique is also a critical factor.  Obviously, the price of filler is dependent on the amount of product utilized and the upper lid blepharoplasty is a short, inexpensive procedure. 

Best wishes,

Dr Kraft

Rhinoplasty, Blepharoplasty & Fillers

If you are planning to have a rhinoplasty and upper blepharoplasty, you can also receive fat transplants to the malar areas for volume restoration. Please contact me directly to discuss costs of procedures and fillers. Best wishes!

George C. Peck, Jr, MD
West Orange Plastic Surgeon
5.0 out of 5 stars 20 reviews

Give longer lasting fillers a try

Thanks for the great question and the photos. An upper blepharoplasty is a great procedure for removal of excess upper eyelid skin. It's difficult to tell if you're a great candidate for this procedure from the photos alone. In my opinion, it looks like you do have some volume loss in your cheeks. Two great fillers for this area are restylane lyse and voluma. They last longer than the juvaderm or restylane you've had in the past. I don't recommend bellafill for a couple of reasons. First is it's a permanent filler so if there where any problems with it, there's no way to reverse it. Second it that bellafill may cause you to have lumps in the long run from chronic inflammation. I hope this helps!

~Dr. Sieber

Surgical and non-surgical options

It is always difficult to tell from a photo but you look like you have nice bone structure but have lost fat/volume in the mid-face.  Volume replacement with fillers such as Radiesse, Voluma and/or the collagen stimulator Sculptra are all good options.  You might also benefit from and upper eyelid blepharoplasty.  Eyelid surgery can be very effective but does not stop the aging process and often the excess skin one sees years after having upper eyelid surgery is a result of changes in the bone structure and lowering of the brows.  This can effectively be treated with long-lasting non surgical techniques that support the brow (fillers, botox etc) or sometimes a brow lift is indicated. Using filler such as Juvederm (off label) in the nose can be very effective for shaping but from what I see in the pictures, your nasal tip may be too wide which usually requires surgery to improve.  A consultation with an injection specialist can clarify if you're a good candidate but from the photos, you'd most likely require surgical intervention.  Sometimes a wide nose can be made to look thinner by injecting the bridge and slightly lifting it but it is not possible to determine if one's a candidate from that with just a photo.  For some patients, that is a partial improvement and they prefer that to surgery.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.8 out of 5 stars 62 reviews

Eyelid surgery and fat transfer...

An upper blepharoplasty would take the heaviness off the upper eyelids. The lower lids are more complicated because it involves both fat and skin as well as the descent of the cheeks. Usually a combination procedure of lower lid blepharoplasty and fat injection does a nice job of smoothing the lower lid area out. Fat can have long lasting effects in this area. Possibly a mini cheeklift at the same time will help restore the drooping in this area as well. 

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 182 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.