One of the first areas that many patients ask me about is their eyes. I remember a women explaining to me that she was always complimented on her beautiful blue eyes. As the years went by, she noted that people stopped commenting on them. After upper eyelid surgery, she remarked that people are talking about my big blues eyes again! Not that she looked different or what did she have done…but just, you really do have striking eyes. The eyes are a tricky area to treat due to thin skin, bulging fat and many lines, but here are some of my thoughts.
No one likes the bags that form under their eyes as they age. These bags are due to herniated peri-orbital fat. As a child, the fat is located under and behind your eye and as you age, it starts to move forward and push against your lower and upper eyelid skin. The only way to truly treat these fat pockets is to remove them. This can be done through an upper or lower blepharoplasty or eyelid surgery. The surgery will take one to two hours and the recovery is only a few days. Most patients do not have to repeat lower eyelid surgery. Occasionally patients will remove a little more skin from the upper eyelid years after the surgery was performed due to skin sagging.
Although a delicious dessert, the thousand lines that form within crepey lower lid skin are not as tempting. So many patients ask about what they can do to make their skin appear more plump. The key is to increase the amount of collagen in the dermis, increasing the volume of the skin. This can be achieved by making small insults to the skin by lasers or chemical peels, triggering the skin to increase collagen production. Some practitioners believe that adding hyaluronic acid, a dermal filler, to this area will thicken the skin and therefore make it appear less crepey. Moreover, eye creams with plumping abilities can also be helpful. Several ingredients in the Doft eye cream were chosen for their ability to attract water into skin to help smooth the appearance of the under eye area.
Under the Hood
As upper eyelid skin ages, patients notice a significant amount of hooding. Sometimes, the extra skin is so impressive that it can touch your eyelashes. For many women, the extra skin affects their ability to apply make-up, leads to a tired appearance and can prevent vision. In come cases, injecting a neurotoxin (Botox, Dysport, or Xeomin) into the upper eyelid can cause the eyelid to rise giving a more awake appearance. In other cases, patients are happier removing an ellipse of skin to give a more tailored appearance. Upper eyelid surgery is often performed in the office under local anesthesia (lidocaine) or can be combined with other procedures in the operating room. When performed in the office, we often give patients three things to help them relax: valium, vicodin and a little Sinatra. It works every time!
Circle the Problem
Dreaded dark circles are a problem for so many individuals. They are a challenge to treat as the cause is multifactorial, including genetics, lifestyle, and environmental stresses. They are partly due to having thin lower eyelid skin and superficial blood vessels. As the vessels travel close to the surface of your skin, they become more visible. Increasing the thickness of the skin could potentially decrease the visibility of the vessels. But the problem is more than just the presence of the vessels, the vessels may also become leaky. Micro leaks can lead to staining of the lower eyelid skin similar to a bruise which can last for weeks. In some families, the darkness is due to a sun-sensitivity or a hyperpigmentation under the eyes and thus lightening creams can be helpful. For others it can be due to puffiness from fatigue-induced swelling, this worsens under-eye bags creating shadows and darkening the circles. The key to treatment is to correctly identify the cause of the circles. Eye products which help restore eyelid skin thickness, constrict blood vessels, and remove pigmentation will significantly help.
Where the Crow flies
More and more young patients are approaching me about their crow’s feet or the wrinkles on the sides of their eyes. Are we be becoming more expressive, creating more lines? Are we more exposed to environmental toxins? Or are we just more aware of these lines now that we know they can be treated? The crow’s feet are very easily relaxed using neurotoxins like Botox, Dysport or Xeomin. Most patients will have injections placed every three to six months. I use very small needles that are imported from Japan to reduce the potential of bruises in this delicate area. I also encourage patients to take preventative measures like wearing sunscreen and using skincare products with anti-oxidants and retinol.