Puffy Undereyes and Jowls? (photo)

          The lower eyelids will likely have the most marked improvement with lower eyelid surgery.  Fillers or fat grafting to the remaining areas can likely produce the most satisfying result with little to no scarring.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

It's difficult to fully evaluate you with only pictures, but you definitely do appear to have puffiness under the eyes, which is caused from protruding fat.  Surgery can be done to remove some of this fat to improve the appearance.  Potentially, surgery could also be done on your forehead and/or upper eyelids to help with those areas.  Fillers can be used to soften the creases between the sides of your nose and sides of your mouth and the marionette folds below the corners of your mouth.  If you are only looking to improve the lines on your forehead, Botox can help with that as well.  

A few years ago, I wrote a book called “The Fine Art of Looking Younger” where I mentioned that looking younger means looking at yourself a few years ago. On average, facial aging changes are a combination of time and genetics.  For me, looking like you did a few years ago retains your character.

If you're interested in retaining the character of your face and want to look fresher, then there is a strategy. A procedure such as blepharoplasty  is not a generic procedure. People make the mistake of believing that all surgeons do upper eyelid blepharoplasty or lower eyelid blepharoplasty the same way. In just blepharoplasty alone, patients may have 5 different opinions from 5 different surgeons. The key here is to find the doctor who shares your aesthetic sense and resonates with you.

When I look at your photos, I certainly agree that rejuvenation of your eyelids, particularly with the lower eyelids where there is puffiness, will be beneficial. Before recommending the particular type of blepharoplasty for the lower eyelids, there is actually 2 ways to do this: one is the transcutaneous approach that is done from the outside of the eyelid, and the transconjunctival approach done from inside the eyelid. As far as the rest of the face is concerned, I always ask the patient what is the dominant feature that they notice the most when they look at the mirror. In my experience, when you address the dominant facial feature of the patient, it increases their satisfaction.

Looking at your jawline, maybe you want to do a liposculpture. Since I cannot tell the skin tone, quality and tightness, I can't tell you whether you’re a better candidate for a liposculpture alone or a limited lift. In my practice, I do my procedures under local anesthesia and sedation under the trademark LITE® Anesthesia. This gives a great advantage for the patient’s lifestyle with minimal risks and a faster recovery period.  I hope that was helpful, and thank you for your question.