It may be possible to address the problem you are experiencing.  If in fact you have excessive upper eyelid skin, this could result in such symptoms.  I would certainly recommend you have a consultation with a Board Certified Plastic Surgeon.

Yes, generally Asian eyelids do not have a well defined fold on the upper eyelid.  Surgical techniques used to create this fold can be used to modify the shape and size of a Caucasian eyelid in individual circumstances.

My recommendations are to treat the individual components of your neurological disease. If the eyelids are your main concern, than either an eyelid lift or lid tightening procedure can be performed. In some cases a "gold weight" may need to be inserted in the upper eyelid to provide additional weight to the eyelid if closure is a problem.


If the "jowls" or skin of the facial region is your concern, than once again a tightening or lifting of the cheeks, jowls or mid face may be performed. If areas in which the skin or musculature have become thinned or atrophic, fat grafts or dermal fillers may be helpful to provide additional fullness and enhance the contour of the facial region. In all cases, a complete evaluation and examination needs to be performed by a board certified plastic surgeon prior to establishing a treatment plan for your options.

Assuming that you are healthy, and have no abnormalities in your thyroid or kidney function, lower eyelid surgery, with or without some sort of filler, can bring about a pleasing change.

As time marches on our facial features change. Our most notable are the features around the eyes, nose and lips that compose what we're describing these days as the “midface.” The eyelids have several layers that contribute to a youthful and to an aging appearance of the midface. They are related to the underlying structures, most evident of which is the periorbital fat - a cushion of "filler fat" that supports and protects the eyeball itself. One of these layers - the orbital septum acts as a "dam" keeping the periorbital fat "in its place.” As we age, this "dam" weakens, allowing the fat to protrude above and below the eyelids giving you the “dark circles.” These "shadowy" areas are seen because the skin is thin over bony areas, in this case the bony orbit margins or “rims.”
Correction defies any topical application of creams, lotions or potions. They also defy surgical procedures of the past. Recently however, over the last eight years, "midface lifts" have become increasingly popular for their "almost invisible" scars around the eyelids and in the scalp (when the endoscope is used). Their design and extent varies from surgeon to surgeon but the principle remains that of elevating the bone lining (periosteum) and with it, its many ligament, muscle and fat attachments that have "drifted south" leaving you with those unwanted "dark circles" along with flat cheeks and eventually "jowls" in the 30’s and 40’s. The procedure has been described as "putting what's fallen back in its place" and has revolutionized the rejuvenation efforts in the "midface" because of its minimal bruising and excellent blending in a relatively short time.



Other procedures to help with the thinness of tissues compounding the 'dark circles' are tissue fillers and injectables of various types, from Sculptra (a poly-lactic acid derivative), to Restylane (a hyaluronic acid product). These are office procedures, which, when done with a small amount of local anesthetic, can yield immediate results with very little "down time.” There are always limits to what "fillers" can achieve but many more are becoming available with FDA approval annually and I suspect we'll have several more options in years to come.

The best secondary rhinoplasty plastic surgeon I know is Dr. Jack Gunter in Dallas, TX. Rhinoplasty after eyelid surgery does not negate the eyelid surgery. There is no relationship.

After discontinuing cortisone ointment, the skin should return to normal thickness after time. However, this can take months. Taking Vitamin C, 500 mg. twice a day will help. Depending on the amount of pigment in your other skin, or your general skin coloring, a chemical peel may be useful (after skin thickness is normal) as well as laser treatment. Eyelid surgery can improve bags or excess skin but does not help dark circles. Botox injections are best for fine line wrinkles.

Upper eyelid excess often contributes to obstructive vision if the excess extends to or below the lash line. Blepharoplasty is a commonly performed surgical procedure which will not only remove the excess skin and sometimes fat, but also will usually enhance the aesthetic appearance.

The best thing I have found for dark circles under the eyes is a cream called Teamine. It is a prescription product that you can get through a plastic surgeon’s office. It takes about 2 weeks before results start to become apparent, but my patients have had much success with it.

Concerning procedures for dark circles under the eyes, in my experience several treatments can provide improvement. First, lower eyelid surgery (blepharoplasty) can correct this problem if the darkened appearance is due to eyelid “bags” that cause shadowing, or due to fine wrinkling and bunching of the skin in the area directly below the lower eyelids, called the “tear trough.” If surgery does not completely solve the problem, a chemical peel to the area may help.

The best method to correct the hooding is to surgically remove the redundant upper eyelid skin and fat and contour the upper lid. Patients are usually back to work within 5-10 days. Sometimes patients with upper eyelid hooding also have sagging of the eyebrows and may, in fact, need a procedure called a brow lift. A board-certified ASAPS-member surgeon can easily evaluate what procedure or combination of procedures will be best. Be sure that you understand the risks of surgery and what to expect during your recovery. Ask your surgeon if he or she has performed many of these procedures and for how long. Most important, ask about board certification. Choosing a surgeon who is certified by the American Board of Plastic Surgery is an excellent method to obtain someone who has a minimum of 5 years of surgical training after medical school, has completed an accredited residency in plastic surgery, and has passed both oral and written examinations. Additionally, selecting a member of ASAPS as your
plastic surgeon helps to ensure a high level of experience in cosmetic surgery.

You do not state what type eyelid surgery you are considering. Fortunately, eyelid skin generally heals very favorably. Scarring following blepharoplasty incisions tends to be very minimal. After consulting with a plastic surgeon, you might find that he or she might want to operate on both sides to better balance the eyelids. Discuss your concerns and expectations with the board certified plastic surgeon of your choice.

If your Bell's Palsy has shown no improvement for more than 2 years, you could be a good candidate for eyelid surgery. Eyelid repair should be able to improve the droopy look but would not affect the dynamic function of the eyelid.

That is a very good question. How your eyes look is dependent not only on the skin of your upper eyelids but also your brow position. At 36, it would be unusual to have droopiness of your brows unless it is something that you were born with (which does happen). Either way, brows are very subjective and you have to fit your brow with your face. If you look in the fashion magazines you will see brows at various heights. I personally feel that you should address problematic areas earlier rather than later. The longer you wait the more accentuated your problem will be and the bigger change you and others will see. While that may not bother you, it does bother some that like to avoid drastic changes.

Plastic surgeons' thinking regarding the best treatment of lower eyelid bags has, in many instances, changed. We now understand that eyelid fat disappears with age, and this may cause the eyes to have a "hollowed out" appearance. Also the cheek pads tend to fall to a lower position. Many surgeons are now performing lifts below the eyes (cheek lift or midfacial procedures), and fat-sparing lower eyelid surgery (instead of removing fat, the fat bulges are used to fill in hollow areas below the eye). The crow's-feet are still a problem. Some of these procedures help the crow's-feet area slightly. Many patients still find that they need Botox if they want the wrinkles greatly reduced in the crow's-feet area.

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No. It depends on whether you have symptoms related to your dry eyes. If you do, and you plan to have surgery on both your upper and lower eyelids, then it would be best to consider treating either the upper or lower lids first, then the other several months later. If you do not have symptoms, then a more conservative excision of skin could be performed and both your upper and lower eyelids could be operated on at the same time.

If it were a member of my own family, I would recommend the traditional method. The scar is 95% in the eyelid fold and cannot be seen. In most cases, there is excess skin as well as fat that must be removed, and this necessitates the traditional method.