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Aging around the eyes frequently is the
first sign of facial aging. Optimal rejuvenation often is
not simply a matter of an upper and lower eye tuck procedure
(called a blepharoplasty). 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 for skin throughout the body. 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 creates a second mechanism
that contributes to an aged look.
REJUVENATING THE UPPER EYE
However, these two aging mechanisms 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 tuck that eliminates excess eyelid skin. 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 |
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through small incisions in the hair (no hair
is shaved), is made possible via the latest in fiber-optic-based
microsurgical techniques. The upper eyelid tuck is performed
through a tiny incision hidden in the natural crease of the
upper eyelid.
A forehead lift 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 injection of fat, chemical peels,etc.—become
necessary.
REJUVENATING THE LOWER EYE
Aged lower eyelids may involve some or
all of the following problems: 1) excess skin, 2) wrinkling
of the eyelid skin, 3) excess muscle under the skin, and 4)
excess fat behind the muscle. Treatment options include one
of two variations of the basic eye tuck procedure. One involves
making tiny incisions, hidden by the eyelashes, to remove
excess skin, muscle or fat. The other consists of minute incisions
made on the inside of the eyelid (called a transconjunctival
blepharoplasty) to remove only excess fat from the eyelid.
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 - located on top
of the cheek just below the bony rim of the eye socket - toward
a position on top of the “smile lines” leaves
the cheek with a hollow, tired 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 bowing or rounding
of the lower lid and a fatigued appearance. This situation
can be corrected with an upper-facelift, or more easily, with
permanent fat injections directly into to the area (the anterior
malar region). Occasionally, procedures to “tighten”
the support mechanism of the lower eyelid may be necessary
to optimize the cosmetic outcome and eyelid function. Fullness
of the mid-face is generally associated with a vigorous, rested
appearance.
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.
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