[23M] Tired eyes because of multiples issues, am I missing something? (Photo)

Excellent question. You're trying to figure out what elements of your physical anatomy are creating the appearance of fatigue, and thereby understand which elemets should by incorporated into blepharoplasty to create and communicate to others a more lively, alert, energetic impression. This is exactly what we do in pre-operative analysis, consultation, and surgical planning. My opinion is that reversing your canthal tilt by Piezo canthopexy, and a 1-2 mm levator advancement with apogee adjustment, and one or two other minor changes would offer dramatic and favorable results... you would look a bit different, but natural, awake, and engaging.

It’s sometimes difficult to make an island based on a single picture. If you tilt your head, your relationship between your pupil and your upper eyelid will change. The assessment therefore is better done either with a series of pictures or with the dynamic assessment as in alignment, examination, or using video. we also typically make an assessment for one part of the body or face in relationship surrounding areas so while you may want to maintain anonymity to make a good assessment, we need to see the full face. You might have a very slight exophthalmos and you may have mild upper island houses. Your upper eyelids do not look like they’re encroaching on your pupils and I don’t think your upper eyelids are blocking your vision at this point.
There is slight excess scleral show in the lower part of your eye and you may have a mild ectropion.
Surgical correction may be indicated. Getting the outcome you’re looking for requires someone to use finesse and doing these procedures well on a regular basis is a bit complex.
To get a more accurate assessment, and begin in the process of finding the best provider, I suggest scheduling multiple in person consultations. Providers who can help you with this include the plastic surgeons, facial plastic surgeon, and oculoplastic surgeon. The background of the surgeon is not nearly as important as their skill and experience level.
Get a comprehensive assessment regarding upper eyelids, lower eyelids, and the relationship between your eyeball and eye socket. As providers recommend a course of treatment. During each consultation, it ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar facial characteristics and have the same procedures the doctor is recommending. An experienced provider should have no difficulty showing you the before and after pictures of at least 15 previous patients. Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures they’ve actually performed.
I cannot emphasize enough the importance of provider selection. Do not assume that somebody is board-certified in any of the above described. Medical field has mastered any one single procedure. You as a consumer need to properly vet providers to make sure they have the skill and experience to deliver consistent quality outcomes without creating problems for you.
There’s no correct number of consultations needed to find the right provider. The more consultations you have the more likely you are to find the best provider. I suggest taking careful notes during each consultation, especially regarding the quality and quantity of before and after pictures shown.
Continue having consultations until you feel very comfortable you found the best provider in your community.
Best,
Mats Hagstrom, MD