Aging around the eyes often is the first place we notice disharmony of the facial features. Therefore, optimal rejuvenation frequently is not simply a matter of addressing the eyes alone. Aging of the upper eyelid, because of its proximity to the eyebrow, is intimately associated with the aging forehead. Similarly, aging of the lower eyelid, because of its proximity to the cheek, is associated with the aging mid-face. As in all aspects of aesthetic plastic surgery, a correct diagnosis and treatment plan is required to deliver the best and most pleasing natural look.

Over time, a person’s forehead begins to descend due to the long-term pull of gravity and a slow loss of the skin’s subcutaneous fat layer, which provides support and suppleness. As the forehead and brows move closer to the eye, they compress the upper eyelid and can result in an apparent fullness. If extra upper eyelid skin is present, it contributes to an aged look.

Rejuvenating the Upper Eye
These two mechanisms of aging call for separate treatments. The first is resolved with an endoscopic forehead lift that restores a person’s forehead to its former youthful position. The second is corrected with an upper eye procedure that eliminates and/or repositions excess eyelid skin, muscle and fat. Depending on each individual’s diagnosis, one or both procedures may be recommended for best results - but they are not interchangeable. Each procedure is designed to address a specific problem. The two procedures may easily be combined during the same surgical operation.

The endoscopic forehead lift, performed through small incisions in the hairline (no hair is shaved) is made possible via the latest in fiber-optic-based microsurgical techniques and has the synergistic effect of smoothing horizontal forehead wrinkles as well as wrinkles between the eyebrows, or “worry lines.” Only if these wrinkles have been present for a long time and are a permanent fixture of the forehead skin would additional treatments such as injectible fillers and or checmical peels be necessary. The upper eyelid blepharoplasty procedure is performed through a tiny incision hidden in the natural crease of the upper eyelid skin. Dr Kornstein routinely employs autologous fat grafting as an integral part of these procedures to restore the youthful contours of the upper face.

Rejuvenating the Lower Eye
Aged lower eyelids may involve some or all of the following problems: 1) excess skin, 2) excess muscle under the skin, and 3) excess fat behind the muscle. When excess skin and muscle is involved a tiny incision hidden by the eyelashes is used to remove skin, muscle and or fat. This approach also provides access for tightening of the lower eyelid muscle to optimize cosmetic outcome or eyelid function. If excess fat is apparent a tiny incision made on the inside of the eyelid is required to remove the protruding fat pad and no visible scar remains.

These procedures address problems created by the presence of small amounts of excess tissue. For skin wrinkling, chemical peeling or laser can stimulate the skin’s production of collagen, crucial for a natural, smooth skin appearance.

Another factor associated with visible aging of the lower eyelid is the descent of a fat pad located on the cheek. Downward movement of this pad leaves the cheek with a hollow, tired and aged appearance. As time passes, the distance between the lower lid eyelashes and the top of the cheek fat pad elongates, lengthening the lower lid “crescent.” As the cheek pad continues to descend, lower eyelid support weakens, leading to a hollowing or rounding of the lower lid and a fatigued appearance. This situation can be corrected with fat grafting alone, or in combination with a chemical peel or an upper high SMAS facelift.

Conclusion
Achieving optimal, lasting, and natural facial rejuvenation requires the correct diagnosis to pinpoint the responsible factor(s) and determine the most appropriate course of treatment. All treatments described herein are available as outpatient procedures and typically require a minimal recovery period of approximately one week.