44 y/o male, I think I need a upper and lower blepharoplasty, and would like opinions on balancing my nose with my face? (photo)

I feel like my nose is too short/upturned and too small in relation to the rest of my face. I'd like a taller (vertical) ridge and more length. Basically a more masculine nose. I'm also dealing with the hoods of my upper eyes feeing heavy all the time with some (minor) loss of peripheral vision... Finally I've got these bags under my eyes and people ask me all the time if I'm tired. Looking for some opinions on what procedures I may be a candidate for suggestions. Thanks in advance.

Doctor Answers 7

Balancing the nose

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In my opinion your nose is not out of line with the rest of your features.  I would rather have you consider treating the frown line and the eyes as you've pointed out.

Nose, eyes

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hessian, based solely on your photos I would counsel you that you need your brows done along with a "SOOF lift blepharoplasty". Making your nose bigger is a difficult task and requires what is known as a caudal advancement of your septum. I've specialized in "only faces" for over 30 years and have only done this approach about a dozen times. Make sure you see an experienced plastic surgeon that does "only faces" and query about how many times they have attempted to do what you desire with your nose. Finally, I would not do the nose with your other procedures. See the video and good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews


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I would leave the nose alone.  As for the eyes and brow you do have a heavy brow. You may need your eyes done but an exam in person would be essential.  Best of luck.  A little botox might help for the corrugator as well.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Masculine nose and eye rejevenation

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Your nose could certainly benefit from added length to bring it more in harmony with the rest of your face.  Rotating the tip down a bit will also help to masculinize it somewhat.  As for your eyes, you are a perfect candidate for upper and lower eyelid surgery to treat the hooding up top and bags underneath. I would caution you away from any procedures that remove the fat on the bottom, but rather, would recommend transposing it into the tear trough areas to help provide upper cheek volume which further improves the youthful, rested appearance. Best of luck!

Justin Cohen, MD
Washington DC Otolaryngologist

Facial evaluation

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Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  With that being said, based on your photographs, you may benefit from a nasal tip derotation to result in a more masculine nose.  Upper and lower eyelid blepharoplasty could also be performed at the same time.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

What procedures?

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A narrative based on the review of the submitted photos.  The gentleman in the pictures looks young and healthy.  Let's keep that look, so one wants to avoid any operated look.  I would also recommend a focused approach.  When I look at the photos what is most striking is the heaviness of the brows and the exaggerated action of the corrugator muscles.  Addressing that region I believe an effective browlift would be in order - either mid brow or endoscopic.  An upper blepharoplasty can be performed at the same time.  The corrugators can be managed through resection and/or botox.  Management of the upper face will produce the most significant facial rejuvenation in the depicted figure.


The puffiness of the lower eyelids can be managed through a transconjuctival blepharoplasty.  Possibly with a skin pinch.

Comments regarding nasal changes are difficult to make since the photos were taken with a lens with a short focal length and hence there is a lot of distortion.  As a general comment,  to overall effectively increase the size of a male nose significant graft materials may be necessary.  Hence I would be prepare for the need for a rib graft.

If a rib graft is necessary, I would perform the nasal surgery as a separate procedure.

All these observations are fairly routine and possible.  Keep in mind, this is a narrative based on the review of photos.  A clinical opinion is dependent on an in-person consultation.

Be well and best regards,

Fred G. Fedok, MD FACS

President, American Academy of facial plastic and reconstructive Surgery

Masculine nose and tired eyes

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Thank you for the photos.  Although you have a nice nose if there are specific changes that you would like to see to the appearance of your nose that you feel would make you look more masculine, these changes can be carried out.  A consultation with computer imaging is the best way to see how these changes will effect the overall appearance of your face.  In terms of your eyelids, I would agree that you would be a good candidate for upper and lower eyelid surgery.  You can have your eyes and nose operated on at the same time if you desire.  You may want to consider Botox or another neuromodulator to the vertical line in your glabella region between your eyes as well. 

Philip S. Schoenfeld, MD, FACS
Chevy Chase Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.