Eyesthetica Eyelid Surgery Self Test Form Step 1 of 13 0% Are you male or female?*MaleFemaleOther How old are you?*39 or less40 - 5960+ Do you smoke?*YesNo Do you have excess skin, puffiness, drooping or wrinkles of the upper eyelids?*YesNo Do your upper eyelids hang low enough to block your vision or have skin that touches or hangs over your eyelashes?*YesNo Do you have puffy or baggy lower eyelids?*YesNo On your lower eyelid, do you have the appearance of excess skin?*YesNo Does your lower eyelid skin and face have deep wrinkles and spots noticeable when you are not smiling?*YesNo Do you have saggy, low set eyebrows?*YesNo 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* What is your first name?* What is your last name?*
