Q. I am a healthy 49 year old woman who is not feeling good about my self-image.  I am showing my age in my face, but not sure what to do that will make me look better.  Where do I start?

A. The first thing to do is to try to determine what it is about your face that is making you unhappy; tired eyes, face wrinkles, sagging skin, brown spots, the list can be lengthy.  If you are unable to exactly put your finger on the issue, then a consultation with a board certified plastic surgeon can give you insight into what changes have taken place that may be robbing your face of its youthful look.  From my standpoint, it is always nice when a patient brings a good quality picture of herself when she was in her 20’s or 30’s just so I can get an idea of her look at a younger age.  I will always advise my patients that I can never restore that 30-something look in someone who is approaching her 50’s, but the goal is to try to rejuvenate the face in a natural way, avoiding changes that make you look like someone you don’t recognize in the mirror.

At a consultation, I will evaluate the quality of your skin, what damage has taken place, and what non-surgical steps can be undertaken to improve the health and quality of the skin.  Before undergoing any facial rejuvenation, I suggest you start with a good medically directed skin care program before proceeding with surgery.  I will then evaluate as to whether you are a good candidate for non-operative wrinkle reduction using fillers such as Juvederm® or Restylane® to fill deep facial lines, or you may be a candidate for Botox® or Dysport® to smooth lines on the forehead caused by years of frowning.  Frequently, the combination of skin care and injectables to the face can rejuvenate the face to the point that surgery can be avoided.  If your primary concern is saggy skin of the cheeks or neck, there is probably little that can be done short of a face or neck lift.  A detailed consultation with a board certified plastic surgeon can be worthwhile to determine what is best for you.

Q. I am a middle aged woman who has very heavy upper eyelid skin.  I feel like I look tired all the time.  I was told that if I have surgery on my upper eyelids that I also have to have surgery on my lower eyelids.  I am not bothered by my lower eyelids.  Can I just fix my upper eyelids without other surgeries?

A. Absolutely, you can just do upper eyelid surgery.  If that is all that bothers you, then just address the problem that concerns you.  What you may have heard is that most surgeons advise doing surgery on both the upper and lower eyelids at the same time, and that is often true.  The reason for this is that the upper and lower eyelids do in fact age together, and to get the maximum rejuvenation of the area around the eyes, it is optimum to perform both an upper and lower blepharoplasty at the same time.  That being said, I have on many occasions done just the upper eyelids or just the lower eyelids in order to address what the patient is bothered by.  I will advise you that it is not uncommon that once the upper eyelids are rejuvenated without doing anything to the lower eyelids, then you may start noticing that the lower eyelids do not really match the upper eyelids in terms of youthfulness.  That being said, do not be talked into having surgery that you are not interested in having.

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William Byron Barber II, M.D. has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com