42 yr old female looking to address my aging eyes. What are my best options? (photos)

Best options for eyelid rejuvenation based on your pictures are a conservative upper eyelid blepharoplasty , laser skin resurfacing around the eyelids and consider some fillers with a fat transfer procedure.

Other non surgical options include laser skin resurfacing, Botox and injectables fillers such as the belotero you already had.

Hope this finds you well. To start you have beautiful eyes! Some options to make them pop even more could be upper lid blepharoplasty, possibly lower lid bleph, filler or fat transfer under the eyes and an annual laser resurfacing. Whoever you decide to go with make sure they have adequate experience with the eyes. Best of luck.

Your photographs are somewhat limited. However, it looks like you have excess upper eyelid skin and you may have some excess lower eyelid skin as well. You may benefit from an upper and lower blepharoplasty. You may also benefit from a brow lift. I would need photographs taken straight on and both side views to give you a more accurate answer.

Best Wishes,

Gary Horndeski, M.D.

You most likely would benefit from lower blepharoplasty and upper blepharoplasty. See an expert for evaluation and treatment.

Based on these very limitted photos upper and lower blepharoplasty would be a good option with full face chemical peel or laser. Periorbital fat grafting or Renova should be considered as well. In person or teleconference consultation with a board certified plastic surgeon with expertise in these techniques is recommended. Good luck.

Thank you for posting your question and pictures here !I am going to start by saying that my answer is based on the limited information and pictures presented , for more in depth answers and a bespoke plan I would recommend visiting a plastic surgeon in person.
That being said , from the pictures it appears that you have some skin laxity in your upper lids , on exam if your surgeon determines that it is the result of skin laxity from the upper lid then they might offer you a blepharoplasty which is a relatively straight procedure that involves removing the excess skin and sometimes some herniated fat. Should your surgeon determine that it is the result of the brow drooping then they might offer you a brow lift (which is also a relatively straight forward procedure that can be performed in a number of ways), they might even determine that it's a combination of both and offer both procedures .As for the lower lid some of the pictures demonstrate what appears to be herniated fat and a prominent tear trough ligament both become more prominent as the person ages and the tissue holding the fat compartments in place becomes more lax, this can be addressed with a lower blepharoplasty ( many ways of doing it , from different incisions to different ways of addressing the fat , this can also be paired with laser treatments)if your surgeon determines that there is volume loss they might also offer some fat grafting.
I hope this answer helps, Best of luck!

From these limited photographs, it does not appear that your lower lids have enough to do that's worthwhile undergoing a lower eyelid procedure. Consider an upper blepharoplasty which can be performed under local anesthesia to remove the excess of skin on your upper lids and a small amount of fat on the inner corners.

A lot of your issues are related to some damage which creates premature facial aging.
Reversing some damage is not really possible, though some people feel that retin A can help.
If you’re not already using daily sunscreen, then starting, that would be a good recommendation to slow down further science of facial aging.
In your last picture, it shows some fullness in the lower eyelids from protrusion of the lower eyelid fat pads.
And the other pictures, your lower eyelids look good with the exception of the sun damage.
I personally do not recommend removing skin in lower eyelid surgery.
Doing so seems to create a premature ectropion sooner rather than later.You have mild putting of your upper eyelids.
A conservative upper eyelid blepharoplasty might help, but if done excessively can lead to a hollowed appearance.
A brow lift could be a better option.
Midface augmentation using fillers in the hands of a really talented provider could give support to camouflage the lower eyelid fat pads.
Botox for the crows feet might be considered subtle, but could also help.
I generally do not recommend people travel long distances for elective surgical procedures.
There’s probably sufficient talent in your immediate community if you investigate what’s available.
The most important variable when it comes to plastic surgery and usually provider selection.
And the hands of the right provider you’ll get an accurate assessment and recommendation and implementation of correctly done procedures.
Schedule in person consultations with multiple providers in your community.
Bring a complete set of facial pictures to use as reference for each consultation.
Take a look at how plastic surgeons take before and after pictures to get an idea.
During each in person consultation, ask each plastic surgeon to open up their portfolio and show you their entire collection of before, and after pictures of previous patients with similar facial characteristics for whatever procedure, the surgeon recommends.
Sufficiently experience provider should have an impressive collection of before and after pictures.
If they don’t then continue looking.
There’s no correct number of consultations to find the right provider.
The more consultations you have the more likely you are to find the better provider for your needs.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
Having only one consultation, more or less eliminates the ability to choose a better provider.
I did not believe patients can adequately select providers by using the Internet.
It is the patient responsibility to adequately vet plastic surgeons. most people do not have experience consulting with plastic surgeons.
By having multiple consultations, you’ll get better at the process.
Give yourself six months and try to schedule 4 to 6 consultations during this time.
You can probably scheduled more consultations in last time, depending on availability of both parties.
Some providers may charge for consultations.
This is not lost money. It is an investment in finding the best provider for your needs.
There isn’t much patience, can do to change to candidacy for surgery.
The only variable patients have that they have control over is provider selection.
This is by far the most important variable, perhaps even more important than what surgery you choose.
In the hands of the right provider you’ll be guided towards having the right procedure.
When in doubt, slow down and schedule more consultations.
Best,
Mats Hagstrom MD