The first patient is a 60-year-old woman who had a bilateral upper and lower blepharoplasty 20 years ago. Postoperatively, the left lower lid was too low and she went back to the same surgeon who operated on the right side. Now she is complaining of tearing and irritation in both eyes.

Of particular concern to her is that her mascara runs. She complains of having to keep her head down to hide this when she is photographed.