The best way to get an idea of what is the best result you can achieve at this point, would be a thorough examination, to look at your facial structure, skin and texture and laxity, fine lines, and brow and eyelid position. It could be that a combination of treatments which may include skin care, resurfacing, a type of brow lift or eyelid,a filler (fat or injectable), botox, or a pinch of skin removal may be indicated. I would consult with an experienced eyelid specialist with an office visit for your next step. Goo luck.
Your brows cannot be evaluated properly based on the limited photos. Would need to see the whole forehead. Theoretically speaking lateral hooding can be improved with a lateral brow lift or temple lift. As to the lids themselves you do have residual excess skin and pending a hands-on exam to determine lid movement and eye closure you may need a revision surgery. It is always best to reconsult with your original PS. Good luck.
By looking at your pics, you have what I call "lateral Hooding" due to excess skin mainly. Your brows are in a correct position. I would advice for a revision but keep in mind that the incision may have to be carried out more laterally to take care of the "lateral roll" of skin.
You do have excessive skin in the upper eyelids which can be removed easily. This might be done under local anesthesia but still requires some mild healing time. At 9 months this is probably the final result. You do not need a brow lift. Two words of caution however: In an effort to create a perfectly flat upper eyelid itI routinely recommend massage as well as head elevation. Taking Arnica Montana, bromelain, and other nutrients will also help. It will take time but I suspect that the results will be worth it. As a side note is better to prevent swelling with elevation, ice packs, salt restriction, etc. than to have to treat it. You should always massage toward the incision line. is very easy to remove too much skin thereby causing an exposure problem. Better to be conservative. Secondly, variations in peri-orbital anatomy including the depths of the eye socket etc. will lead to variations in result even using the same surgery. Therefore do not expect to see your eyelids looking like your favorite movie star's eyelids.
You do have some extra skin still present. Your brow looks to be at a good height, but you don't have much of an arch. A temporal browlift, where just the outer part of the brow is lifted may help with this extra skin. When you see your surgeon, they can elevate the brow temporally and you can decide if you like that. You also have a ptosis , worse on the right. When extra skin is removed you may want to fix that too. See an oculoplastic surgeon for this.
Photographs demonstrate hooded excess skin on the upper eyelids. The brows are in excellent position eyebrow lift is not needed. An additional cleanup of extra skin should be probably all that is necessary, but a examination is needed to confirm. For many examples, please see the link below
Thank you for the photos though a full examination is really needed to determine what procedure or combination of procedures would give you the best result.
Revision upper blepharoplasty is what you need since your brow position looks good. Of course an exam would be best. Choose an experienced surgeon who does good natural work and not because he has membership in a certain group.
It seems from your pictures as though additional improvements can be made. Typically, however, removal of too much fat can make the eyes look hollow, rather than removal of skin. If you remove too much skin it can cause bad scarring and/or difficulty closing the eyes. I am also a little unclear how removal of muscle from above the eyebrow will help the lid? Perhaps your doctor is suggesting a brow lift and/or there is some confusion? I would certainly wait several months after your last surgery to consider revision as you could have some residual swelling in place. It sounds like you need another discussion and clarification--consider a second opinion. As always, when considering a surgeon please make sure you find a board certified/eligible plastic or oculoplastic surgeon to address your concerns. Good luck!
Dear Xans, An examination would need to be done where it is possible to view the entire top third of the face to determine brow position, mid face laxity and volume, skin tone as well as the upper lid laxity. An endoscopic brow lift with mid face can be done with a few minimal incisions in the brow area allowing the surgeon to undermine below the zygomatic arch shifting the entire plane back to it's pre aging position. While it is considered a brow lift you do not need to elevate the brows high as you are not removing any skin from the region. You are basically shifting the area to it's pre aging position. This allows a very natural youthful appearance and is often done prior to upper lid blepharoplasty. Once the brows are in perfect position if excess skin remains then a small sliver may still be taken out to remove any excess skin. You can see many examples of endoscopic brow lifts on the link below which will show you the natural appearance this procedure provides to patients. When patients come in and have statements that they" feel like they look tired or angry" then this procedure is one of the most popular procedures with a very high level of patient satisfaction. Digital imaging is also helpful to see the proposed results. Best regards, Michael V. Elam, M.D.