What is the best treatment for my upper and lower lids? Thermage, surgery? Thank you (Photo)

Your upper eyelids would benefit most from a simple skin only blepharoplasty done conservatively.  This would effectively remove the hanging skin from your upper eyelids and give them a more open and alert appearance.  The lower eyelids can be treated with fillers to the trough below the eye but it is temporary.  A permanent solution can be found in removal of the fat bulge from the lower lid or fat repositioning.  Each gives excellant results in the proper hands.  The non-surgical treatments (lasers, Thermage,etc) which were heavily marketed to tighten skin have not lived up to their promises.

When we speak of rejuvenating the eye unit, we are talking about all the aesthetically important areas that surround the eyes, namely the upper and lower lids (including the upper cheek region immediately below the lower lids); the brows; the periorbital area to the sides of the eyes; and glabella area between the eyebrows. Today, happily, each of these regions may be improved nonsurgically (i.e. without cutting, stitches or prolonged healing and downtime. In this case, the problems appear to be heaviness of the brow region and flattening of the upper inner cheek and under eye regions and the development of tear troughs.I can only make some general comments about eye unit rejuvenation goals that can be achieved nonsurgically. For example, a few microdroplets of Botox or other neuromodulator (such as Dysport or Xeomin) placed in the glabella area would help to not only lift, but reposition the slight downturning seen there. Prominent flattening of the upper inner cheek areas can be improved significantly with the use of a volumizing filler, such as Juvederm UltraPlus XC (which will likely also have the secondary benefit of improving the regions directly below the eyes. The tear troughs and hollows of the lower eyelid can be addressed with injectable fillers--my preference here being Belotero Balance, since it is unlikely to give rise to the bluish discoloration, known as the Tyndall Effect, sometimes seen with other hyaluronic acid fillers when injected superficially or within the very delicate tissues around the eyes. Consultation with a board certified aesthetic core physician with extensive experience in nonsurgical eye rejuvenation techniques would be strongly advised so that a specific treatment plan can be formulated.

I would predict that Thermage will leave you disappointed. Your upper eyelids would benefit from a CONSERVATIVE upper blepharoplasty. The under eye region could be improved non-surgical with filler injection to correct the tear-trough deformity. Best results with most longevity would be accomplished with lower blepharoplasty with fat repositioning.