In the Media

ADVANCES IN EYELID SURGERY

BY STEVEN BLOCH, M.D.

Our eyes are our most intriguing and revealing facial feature. How we see the world and how the world sees us is revealed in the expression and appearance of our eyes. Whether we are tired, angry, joyful, sad, frightened, old, or young is revealed in the appearance of our eyes. For many, the first signs of aging occur around the eyes. The early "crow's-feet" (hooding of the upper lids or "bags" of the lower lids) are some of the early stigmata signs. These signs can often convey a state of being that is not consistent with how we feel about ourselves. This inconsistency creates an inner anxiety; when this anxiety reaches a high enough level, one usually seeks the help of a plastic surgeon. Fortunately, there is help and there are many options.

If the changes are recent and sudden, other medical causes should be looked into, such as thyroid, metabolic, allergic, infections, or cardiac issues. Once other medical problems are ruled out and the natural aging process or heredity is ruled in, a plan of treatment can be formulated. For the patient who seeks some improvement in achieving younger looking eyes and does not want any surgery, Thermage is the only noninvasive procedure that helps smooth and tighten skin, decreasing wrinkles and hooding without surgery or injections and little to no downtime.

How Thermage works:

As we age, our collagen stretches, skin sags, and wrinkles appear. Eyes by Thermage delivers heat via radio frequency waves into the skin to stimulate collagen shortening and new collagen growth. The effects continue to improve over months. The benefits include tighter, smoother skin, improved contour, and softer, fine lines. Individual results may vary depending on age and skin condition.

If you're not into the noninvasive approach and want something more definitive, then eyelid surgery may be more appropriate. In general, a blepharoplasty corrects the excess skin, tissue, and fat that contribute to puffiness and bags in both the upper and lower eyelids, revealing a more youthful appearance. To correct droopy or excess skin of the upper eyelid, an incision is made within the natural crease of the lid. Excess fat deposits are removed or repositioned. Excess skin is removed to create a firmer upper eyelid contour. No longer will eye shadow get lost in the folds. The incision for the lower lid can be approached tranconjunctivally (hidden inside the lower lid), thereby eliminating any external incision. Excess fat is removed or redistributed and sagging muscles can be tightened. To tighten the skin and improve the skin texture, laser resurfacing of the lower lid skin can be done at the same time. Recent introduction of Fraxel CO2 gives, in my opinion, superior results with greater safety and faster healing than any other method- and I've used them all.

Occasionally, an incision just below the lower lash line is an alternative technique allowing for removal of excess skin in the lower lid. Where a low positional brow or crow's-feet at the outer corner of the eyes contributes to the aging appearance of the eyes, a brow lift may be indicated. This procedure can be done in conjunction or in lieu of eyelid surgery. Other advantages of a brow lift can be the reduction of a furrowed brow. As one can see, there are multiple choices and options. To find out what is right for you, seek out the consultation of an experienced plastic surgeon.