My eyes look tired 4 years after upper blepharoplasty. What can be done - an eyebrow lift or second blepharoplasty? (photo)

To address this, you need a surgeon who actually understands this syndrome. I have published the only paper on this topic. I have placed a web reference to you can read about this syndrome and how it can be repaired. In short in includes upper eyelid ptosis, eyelash ptosis, high or absent upper eyelid crease, loose crepey upper eyelid platform skin, and compensatory eyebrow lift. Well meaning oculoplastic surgeons may offer you ptosis surgery. However most ptosis surgeons  strongly predisposed to only offer a type of ptosis surgery called a mueller's muscle conjunctival resection ptosis surgery. Four out of 5 ptosis surgeries in this country are performed this way. Unfortunately, this procedure is not good in the setting of PUBS. That is because internally scaring from the blepharoplasty causes the main tendon that lifts the eyelid to centrally disinsert. When this tendon is out of  place the Muellerectomy is not very effective. That under correction means the eyebrows will not relax down, which will be a big part of what you need to help make the eyes look normal again. What you need is an anterior levator resection ptosis surgery, an anchor blepharoplasty, crease lowering, and reposition of anterior orbital fat into the upper eyelid fold. The anchor blepharoplasty is needed to make a hard crease and support the upper eyelid lashes. Also I suspect that you need the lateral canthus repositioned. There is no substitute for a detailed in person assessment. Your eyes can be your best feature.

Your images suggest a mild upper eyelid ptosis. This can only be evaluated correctly in a consultation, since a photo taken slightly from below can also mimic this problem. I addition, there seem to be some volume loss in the upper eyelids and more significant skin excess in the lateral part of the right upper eyelid. Volume restoration can be carried out in the upper eyelid using fat transfer or advancement of the orbital fat if there is still adequate amount available. A change in the lateral contours of the upper eyelids changes the expression of the eyes whether it involves canthopexy or not. If the lower eyelid position is slightly low on straight gaze, a canthopexy to lift the corner of the eyes may also be of benefit.

You may benefit from upper eyelid ptosis surgery and filler. Not sure if another blepharoplasty is needed. Best to have more detailed evaluation in consultation. See an expert.

Hi, I believe you may be bothered by the asymmetry of your eyelid creases. This is where your eyelid folds back in when it is open. If you notice, the eyelid crease is a lot higher on the right side on your photo - we can “reset” the eyelid crease so that it is more symmetric with the other side and looks less “tired”. This is definitely a job for an oculoplastic surgeon who specializes in eyelid surgery solely. 

Thanks for the question and photo.   Although nothing is as important as an in patient consultation, I notice that you lift your left brow slightly.   You may have a slight eyelid ptosis on your left as well.  See someone in person so they can evaluate you in person.

Thank you for your question and photo. it looks to me like there's a few things going on here. First, you may have some upper eyelid ptosis which can contribute to a more fatigued appearance. Additionally, in your previous surgery, it looks like there was some fat removed from your upper eyelids. You might benefit from a little bit of filler to help to volumize the area. In my opinion, the next best step would be a consultation with an oculoplastic surgeon. Best of luck!

From your photo it appears that you have persistent fullness laterally where the thicker brow skin falls into the outside of the upper lid. You may benefit from a temporal brow lift. Please select a plastic surgeon board certified by the American Board of Plastic Surgery and preferably a member of the ASAPS (American Society of Aesthetic Plastic Surgeons).

hello and thank you for your question. It is possible that you have bilateral upper lid ptosis which appears symmetric. If that bothers you then you may consider ptosis surgery. Additionally if you are feel that your tired appearance is due to your inferior scleral show and slightly  widened lateral scleral triangles you may consider a canthopexy procedure. A physical exam will be needed prior to any final diagnosis since this photograph is not enough.
I wish you all the best!
Inzhili Kitto MD
Plastic Surgeon, Fellowship trained Oculoplastic Surgeon

Thank you for your question and photo. You appear to have ptosis. This uusally responds well to surgery.. A thread lift will not fix this, You may benefit from lid surgery, but you really need an appointment with a fellowship trained Oculuplastic surgeon. A virtual appointment would be a good place to start and an in person exam and consolation after it is safe to do so to get an adequate exam and develop a realistic treatment plan. Best of luck.