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More on eyes….

Posted March 27, 2015 in Blepharoplasty


Last time we talked about eyelid surgery for “bags” under the eyes or excess skin on the upper lids.  That’s a great answer for those concerns, but what if that doesn’t exactly fit you?

Extra skin

Some people may not see fullness, but notice extra skin that you can actually hold between your fingers.  This can be on the upper or the lower lids.  This can also be addressed with eyelid surgery or blepharoplasty.  The incisions are within the crease on the upper lid and just below the lashes on the lower lid and hide very well.  The extra skin is simply excised, making the lids smooth and refreshed.   Often the excess skin is removed in conjunction with excess fat on the lower lids.

Expressive lines

Repetitive movements of the muscles around the eyes and sun exposure can create fine lines around the eyes, between the brows and on the forehead.  For lines on the forehead, between the brows and in the crowsfeet area, Botox is a quick, easy and effective treatment!  It relaxes these muscles and can smooth these areas, as well as prevent future wrinkles.  Sometimes the 11’s, or lines between the brows can be deep even with Botox, if the muscles are very strong.  A small amount of filler injected by an experienced injector can help smooth this area.  There are very important blood vessels here, so you want someone who knows their anatomy.

Fine lines at rest

Other lines that are still visible after the muscles have been relaxed with Botox may be etched into the skin or may be on the eyelids, themselves.  Fine or etched lines are best addressed with a resurfacing laser, like a CO2 or Fraxel laser.  These remove the sundamaged skin and your body replaces it with new, smoother skin.  The choice of laser depends on the depth and number of lines, as well as the amount of downtime you have to dedicate to the recovery.

The opposite of “bags”

Other people may see hollowness rather than bags.  Often, this is because the cheek fat pad is in a lower position than it once was, revealing the orbital rim (bone around the eye).  Since the skin is so thin here, it becomes easier to see.  We can also see this many (often 10 or more) years after a lower eye lift, or blepharoplasty.  We tend to have less soft tissue in the face, including the fat, over time.  As this occurs with orbital fat and too much orbital fat was taken out during the surgery, the eye can have a hollow appearance.   A few ways exist to fill this low area.  The simplest is to inject a soft tissue filler, like Restylane.  This can be done in the office in about 10-15 minutes with numbing cream.  Since this is not an area that moves very much, it can last longer than a year.

For people who have had surgery before, the more permanent and natural option may be desirable.  This area can be filled with biologic material that is already in your body, like fat or biologic matrix of acellular dermis.  These do require a surgical procedure, but the recovery time is minimal. Every surgeon has their preference, but I prefer the matrix because of the variability of fat survival when transferred and possible complications that could affect your vision. These are options to discuss with a plastic surgeon, as each has pros and cons.  Implants are made for this area, but I strongly advise against any synthetic implants in this area.  The skin is very thin and the potential for complications outweigh the benefits.

Eyebrows frame the eyes

Sometimes it’s not the eyes that need a lift, it’s the brows!  In some people the brows descend over time, making the eyes look heavy.  Modern techniques allow us to lift the brow to where it used to be in a very natural way (no surprised looks!) with only about 1 week of downtime and tiny incisions in your hair that are very difficult to see.  It is useful look at pictures of you 10 years ago to see if your brows have changed.  If this is the case and you use one of the techniques above to address the eyes without considering the brows, the eyes will continue to look “tired” or return to being “tired” quickly after the surgery.  Therefore, it is important for you and your surgeon to evaluate your entire face and have an understanding of exactly what is going on and how to keep you looking your best.

Posted in: Blepharoplasty