Why might your face look tired or upset when you feel fine? Brow position, forehead lines, excess eyelid skin and the contours around the eyes can all contribute. In part one of this discussion, Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains why identifying the underlying anatomy matters before choosing treatment.

Originally published August 11, 2020. The recording reflects treatment approaches and practice preferences at that time. Part two addresses the lower face.

Key takeaways

🔎 Resting and movement lines

Lines visible at rest and lines produced by movement are different findings. Dr. Smith explains why they may call for different approaches.

👁️ Brow position

A descended brow can make upper eyelids look heavy. Removing eyelid skin alone may not address the main cause.

👁️ Upper eyelid anatomy

Upper eyelid assessment includes skin, fat and muscle, as well as whether the eyelid itself lifts normally. Eyelid ptosis is distinct from excess skin.

🔎 Under-eye shadows

Under-eye darkness can involve pigment, contour-related shadowing or a combination. The episode discusses why treatment depends on the cause.

📷 Photography and lighting

Before-and-after photographs should have comparable lighting. Small changes in light can make eye-area shadows and contours look very different.

🎧 Episode guide

00:00 — Introduction

01:40 — Forehead lines and brow position

05:44 — Brow heaviness versus eyelid concerns

07:56 — Eyelid function and ptosis

09:08 — Lower eyelids and under-eye shadows

16:21 — Comparing before-and-after photographs

💬 Common questions

How do a brow lift and an eyelid lift differ?

A brow lift addresses the position and laxity of forehead and brow tissues. Blepharoplasty addresses selected eyelid tissues. Dr. Smith describes examining their relationship because brow descent can contribute to apparent upper eyelid heaviness.

Are dark circles always a pigmentation problem?

No. The recording distinguishes darker skin pigment from shadows produced by the shape of the lower eyelid and surrounding tissues. It discusses options such as adjusting fat or filling a depression when anatomy supports that approach, without presenting one treatment as appropriate for everyone.

What should I look for in eyelid surgery photographs?

Dr. Smith recommends checking whether lighting is comparable, including the reflections visible in the eyes. Images can help illustrate an approach, but cannot predict an individual's result.

🔗 Related information

Read about brow lift surgery, eyelid surgery, and facial fat grafting, or schedule a consultation to discuss the cause of your concern and the risks and limits of possible treatments.

About the host — current biography

Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.

Educational information, not individualized medical advice. Treatment suitability, recovery and results vary. Show notes updated September 30, 2026.

Full transcript and related resources