Cosmetic Eye Surgery Candidate - what procedure would address lowered eyebrows, downturned eyes and a tired look? (Photos)

Question

I’m turning 35 in October and lately I’ve been very self conscious of my eyes (ignore colouring to hide pupils). I don’t like that my eyebrows don’t seem as lifted, I don’t like that my eyes don’t have an upward turn, and my biggest issue is that I always look tired under my eyes. My eyes always have a reddish/brown tint around them as well What would help me here? Upper and/or lower bleph? Filler? Other procedures or enhancements?

Carl Truesdale, MD · Answer

What you're describing has a name in aesthetic facial surgery: the 'tired triad' of brow descent, lower lid descent (negative canthal tilt or scleral show), and upper lid heaviness. Each piece is addressable, and the strongest results come from doing them together.
Brow descent component:A temporal brow lift (or sometimes a full coronal or endoscopic brow lift, depending on degree) elevates the lateral brow back toward its youthful position. The temporal lift is the most common because it specifically targets the lateral brow tail without overcorrecting the central brow position. Recovery is quicker than coronal.
Downturned eye / negative canthal tilt component:A canthopexy (subtle) or canthoplasty (more powerful) tightens and elevates the lateral canthus to restore a more horizontal or slightly upward tilt. This is the move that genuinely changes the eye shape from sad/tired to alert.
Tired upper lid component:Conservative upper blepharoplasty if there's true skin redundancy. Important note: if your brow is also descended, you need brow lift FIRST or AT THE SAME TIME. Doing upper bleph alone on a brow-descended patient often makes the brow drop further and creates a hollow, surprised look.
When these three are combined in one operation, the result is dramatic and natural because they were designed together. Done piecemeal, results can look 'off.'
A good consult should evaluate brow position relative to the orbital rim, marginal reflex distance (lid position vs pupil), and canthal tilt angle. Bring clear front and three-quarter photos.
Find a surgeon experienced specifically in upper-face aesthetic surgery. This is precision territory and surgeon volume matters more than for many procedures.

Zoran Potparic, MD · Answer

It would be more appropriate to sent a photo that shows the area of concern in natural presentation since it is already difficult to an experienced surgeon to make a suggestion without in person evaluation. However, based on this photo, a lower blepharoplasty, transconjuctival and periorbital fat grafting would be my suggestion. In person consultation with an experienced board certified plastic surgeon would give you an opportunity for better evaluation and detailed discussion about options. Good luck.

Cosmetic Eye Surgery Candidate - what procedure would address lowered eyebrows, downturned eyes and a tired look? (Photos)

Answers (2)

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