The combination of the excess skin on her upper lids and the vertical creases between her eyebrows makes her look like she's scowling at you in the before picture.  But she's not.  Her face is in repose.

Ideally, we might have thought about elevating her eyebrows, but you don't have to do everything.  That would have entailed another trip to the operating room, since I don't like to elevate the brows at the same time as taking excess skin off of the upper eyelids.  We simply planned as much improvement as we could get while minimizing trips to the operating room.