Eyesthetica Eyelid Surgery Self Test What is your first name?*What is your last name?*What is your email address?* (So that we can provide you with the results to this quiz)Please provide the best phone number to reach you at*Are you male or female?*MaleFemaleOtherHow old are you?*39 or less40 - 5960+Do you smoke?*YesNoDo you have excess skin, puffiness, drooping or wrinkles of the upper eyelids?*YesNoDo your upper eyelids hang low enough to block your vision or have skin that touches or hangs over your eyelashes?*YesNoDo you have puffy or baggy lower eyelids?*YesNoOn your lower eyelid, do you have the appearance of excess skin?*YesNoDoes your lower eyelid skin and face have deep wrinkles and spots noticeable when you are not smiling?*YesNoDo you have saggy, low set eyebrows?*YesNo
