From cringing and smizing to widening in
surprise—you need only scan the emoji
roster on your phone to grasp the range
of emotions the eyes can express. Not
pictured in that lineup, however, are their
less-intentional communications—exposing worry and
fatigue, or betraying age.
Thin-skinned and highly mobile (think: 20 blinks per
minute), the eye area is typically the first to show signs of
aging. As the delicate skin of the lids turns crepey and lax,
underlying muscles and tendons weaken and drop, allowing
fat pads to push forward and bulge out into bags, which are
often magnified by the sharp contrast of adjacent hollows
in the tear troughs.
You May Also Like: Why I Got an Eyelift
Whether doctors are treating under-eye bags, loose skin,
hooding or shadows, blepharoplasty, often referred to as an
eyelift, is a safe, long-term solution that can restore volume
and smooth contours to natural effect. Hallmarks of the
modern-day eye job include minimally invasive techniques,
near-invisible scars and a forward-thinking focus on
preserving precious fat rather than removing it altogether.
But, if you’re not quite ready to commit to surgery, injectables
and energy-based devices can offer a subtle short-term
rejuvenation. Here’s a closer look at all of your options.
What to Expect
A Thorough Consultation
Even before measurements and
markings, “we start by asking the
patient about their desires and
concerns,” says Boca Raton, FL
oculoplastic surgeon Steven
Fagien, MD. With women, for
instance: Do they want more area
to put makeup on? Are they fearful
we’re going to raise the crease?
Ethnic and cultural considerations
are also important: Is the patient
Asian and wanting to keep certain
aspects of their ethnicity? The
answers to these questions will
ultimately shape each individual’s
treatment plan. An accurate
aesthetic assessment follows.
A Dry-Eye Evaluation
Those prone
to dry eye may not be candidates
for blepharoplasty because
“the procedure can worsen the
condition, most certainly in the
short-term and perhaps in the
long-term, as well,” says Beverly
Hills, CA facial plastic surgeon
Sarmela Sunder, MD, explaining
that the physiology of the eye is
upset for a period of time during
healing, compromising lubrication.
In some people, “removing muscle
can also affect eye closure, which
can contribute to dryness,” she
adds. Patients who have undergone
LASIK procedures to improve
eyesight are typically prone to
dry eyes afterward, because the
nerve supply to the cornea is
disrupted, and tear production
suffers, says Eugene, OR plastic
surgeon Mark Jewell, MD.
Low-Risk Anesthesia
Most
blepharoplasties are performed
in one to three hours under local
anesthesia with intravenous
sedation to minimize complications
and recovery time. General
anesthesia may be used if the
surgeon prefers it or the patient
requires it for medical reasons.
Nearly Invisible Scars
Incisions
are made in the natural crease of
the upper eyelid, or in the lower
lash line. They blend in well with
the skin once healed.
Manageable Downtime
Seven
to 14 days, depending on the
extent of the surgery; no strenuous
activity for two to three weeks.
“Lower blepharoplasties are
generally more complex,” says
Dr. Fagien, “and at times, it can
take up to four or six weeks for
swelling to fully resolve.”
This Bleph’s for You: Top, Bottom or Both?
Upper
This procedure targets upper eyelid
hooding—“the excess tissue that
protrudes over the eyelid’s crease,”
says Atlanta plastic surgeon Mark Codner,
MD. Depending on one’s anatomy,
ethnicity and extent of aging, the surgery
may also address surplus fat at the
inner corners of the lids near the nose,
as well as slack skin and possibly
muscle. Techniques vary: Some
surgeons preserve muscle and central
lid fat “to maintain or enhance
volume in the upper lid,” says Dr. Fagien.
Others choose to remove
equal amounts of skin and muscle. Average Treatment Cost
$1,750–$5,000
Lower
Lower eyelifts remove distended fat
(bags), resuspend sagging muscle and
pare loose, crepey skin. In patients with
firmer skin, the procedure is quite simple:
Through an incision hidden inside the
eyelid, surgeons can obliterate the fat
bulge and the shadow it casts. For those
in their late 40s and 50s, the operation
generally becomes more involved,
necessitating an incision along the lower
lashes. “With the subciliary approach,
we not only remove extra skin and tighten
the lower lid skin, but also tighten the
muscle underneath,” explains New York
plastic surgeon Mokhtar Asaadi, MD.
Average Treatment Cost
$2,500–$5,000
To better match her eyes to her true age, Palo Alto, CA facial plastic
surgeon Jill L. Hessler, MD performed a lower blepharoplasty with
fractional laser resurfacing on this 29-year-old patient.
Combination
Upper and lower blepharoplasty together
addresses the top and bottom
lids to varying degrees for an overall
refresh. The procedure may also
incorporate an endoscopic browlift
(more on that ahead) and/or autologous
fat sculpting—”free microfat grafts
directly placed with forceps below
the orbital rim to blend the lid-cheek
junction for a smooth, natural result,”
says New York plastic surgeon
Glenn W. Jelks, MD. The fat is the
patient’s own, typically the excess taken
from the lids or, when necessary, a
modicum harvested from the abdomen.
This 69-year-old patient was bothered by her droopy eyelids, so she sought
Short Hills, NJ oculoplastic surgeon, Baljeet K. Purewal, MD for an upper
and lower blepharoplasty and ptosis repair.
Rules of the
Modern-Day
Eyelift
Don’t Delay
“Everyone develops heavier
upper eyelids with age as
the skin loses elasticity,” says
Dr. Jelks. But many folks, in
a move to delay surgery, will
“use compensation methods
to try to raise that excess
skin off their lids so they can
see better, thereby causing
secondary problems—
horizontal forehead lines,
deep furrows between the
brows and high brows.”
Less Is More
“Back 20 or 30 years ago,
we basically took everything
‘excessive’ out of the lids—
skin, muscle, fat—and created
a big change. At the time,
some believed it was amazing.
But really, we debulked
the lids and left people with
a hollow look,” recalls Dr.
Fagien. “Eyelifts of today
should fix the problem
without removing anything
that doesn’t need to be.”
Recycle Fat
“We can now take fat that’s
been removed from the
lids, mince it into a paste-like substance and use it to
smooth the area between
the lower lid and cheek,”
says Dr. Codner.
Should I Get a Browlift Too?
While the heft of a fallen brow can weigh on the top lids, plastic surgeons
are split on the usefulness of a surgical browlift. Here, all sides of the issue.
NO Some have all but abandoned the browlift,
citing unacceptable side effects (hair loss,
numbness, scarring) and the procedure’s
relative impermanence (“brows notoriously
do not stay where you put them,” Dr. Jelks
laments). According to Dr. Fagien, browlifts
of the past were often misguided and
overprescribed: “Many patients are absolutely
fine with upper blepharoplasty alone.”
However, he concedes, certain low-browed
women may still need a lift to notice a
real change in their upper lids. Minor
improvement of the brows can be achieved
by elevating them through an upper
blepharoplasty incision, but La Jolla, CA
plastic surgeon Robert Singer, MD notes this
is not as longstanding or reliable as a limited
temporal lift (to elevate the lateral aspect
of the brow) or an endoscopic lift.
YES
Dr. Codner, who pairs browlifts with upper
blepharoplasty in 20 percent of his eye
cases, says he considers brow position
and stability during every eyelid consult.
“If the brow is low and loose, it exacerbates
redundant skin and muscle on the upper
lids,” he explains. “If you do a blepharoplasty
without first lifting and stabilizing the
brow, you can make the problem worse.”
He performs all brow lifts endoscopically,
creating three quarter-inch incisions
behind the hairline, and says, “I’ve had
results last well over 10 years, and am
absolutely convinced that an endoscopic
browlift, when performed correctly on the
right patient, is an effective procedure for
elevating the brow and improving the result
of an upper blepharoplasty surgery.”
Sugar Land, TX plastic surgeon Peter Chang, MD performed an upper
and lower blepharoplasty, browlift and laser pearl fractional skin
resurfacing to give this 62-year-old patient an eye rejuvenation.
Youth Movement
In Los Angeles,
Dr. Sunder is actually
seeing a spike in
browlifts among younger
patients seeking a subtle
but lasting boost to
their eye area. “Some
want just the lateral part
of the brows lifted to
create a cat-eye effect,
like Bella Hadid, others
want the middle portion
of their brows raised
along with the sides for
more of an Ariana Grande
look,” she says. Both
can be achieved with
a conservative
endoscopic browlift.
3 Surgery-Free Solutions for Aging Eyes
A Chemical Browlift
Neurotoxins work by weakening muscles. And,
relaxing certain muscles can cause opposing
ones to perk up. “If you’re very precise in
injecting the brow depressors [or downward-pulling muscles] in isolation, you will get a
compensatory, reflexive strengthening of the
brow elevators, which give a lifting effect,”
explains Dr. Fagien. (This injection technique
requires a strong understanding of facial anatomy
and is best left to board-certified plastic surgeons
or dermatologists.) Doctors will sometimes
incorporate hyaluronic acid filler, as well, using
it to build up the aging brow, so it can better
support the overlying tissue and keep it from
falling into the eyes, notes Dr. Sunder.
Filler in the Tear Troughs
“There’s no reason why we can’t obliterate a tear
trough with careful injections of a low-viscosity
hyaluronic acid filler, like Belotero or Restylane Lyft. The problem is, fillers are expensive, and
they don’t last forever,” says Dr. Jelks. What’s
more, they’re not a universal fix, and generally
work best on young patients with thicker skin that
can conceal the product. In any case, whether
altering the under-eye with surgery or injectables,
“we want to preserve the natural shape of the
lower eyelid,” says Dr. Fagien. “From the lower
lashes to the cheek is not a bulge or convexity—
it’s a gentle slope that is slightly concave and
blends in with the ogee curve of the cheek.”
Skin-Tightening Treatments
“Radio-frequency treatments shrink and tighten
the skin on the eyelids, and also on the face,
neck, arms, abdomen and legs,” says New York
dermatologist Ellen Marmur, MD. One device in
particular, Thermage, is approved for up to a five
millimeter eyelid lift, she adds, and can help with
lid laxity, hooding, bags and wrinkles. Results
are best seen after six months of new collagen
growth. “Delivering ultrasound energy to the
forehead region via Ultherapy treatments is
another effective, noninvasive treatment to
minimally lift the brows,” says Dr. Jewell.
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