hi guys welcome back to the channel i'm sat here again today with the oculoplastic surgeons from
face restoration we've got rashner and jonathan and today we are going to be talking all about
lid lifts as we age again i hate to be the one who talks about aging because i'm i'm
already grey but when you um as we age some of us notice that our lids start feeling either heavy
or that they're affecting our vision or that they just make us look more sleepy is this just saggy
skin or is your lid actually low and the best way to check that is to look at your pupil you
can look in the mirror and your pupil should not be covered by the margin of the lid that would
tend to suggest that you have something called the ptosis which is where the lid itself is low
and that tends to happen either with age or with certain medical problems and so it's important to
investigate those but the most common thing that happens is the skin gets saggy so even though the
lid is in the right position you get skin above that starts hanging down on top of that lid margin
really wish that i had a mirror right now because i need to check myself out yeah which is why i was
i was looking right at the camera just sent so you can see where my people were sitting because mine
is slightly wonky but uh slightly wonky yes so i mean we all have a bit of asymmetry uh not at all
not all of us some people are perfect but most of us have a bit of asymmetry and i think most of us
will have a degree of a slightly lower eyelid on one side compared to the other if your muscle here
that normally lifts the eyebrows drops down it can make it look like you have this extra skin and the
danger is if you remove the skin and then it turns out that actually it was your eyebrows and once
you have your eyebrows lifted you're not you won't be able to close your eyes anymore there are lots
of things to think about you've got to think about the eyebrows you've got to think about the actual
lid movement and you've got to think about the skin and whether the eyes are dry what sometimes
happens is that you'll have a um a person who wants a rejuvenation they feel like they're
starting to look a bit tired and so they go in and they have a procedure and if you do too much
and remove too much fat or too much skin you can actually because this is such an important area
for identifying who we are um you can actually end up completely changing your appearance and you can
become unrecognizable and that's happened to a few very famous hollywood actresses who've had
very good surgery but it's made them look like someone else and you're going to say it no are
you going to say it did i say it you say it are you talking about running well maybe um we're
just going to go a little bit boring sciency for a second but in the 1960s there was this
famous russian scientist and he did something called gaze tracking studies so basically he put a
camera up and looked at where we look and when we first meet the first thing we do is we look at
the eyes and we go backwards forwards backwards forwards then we go down to the mouth because
that tells us a bit about the expression is it a smile is it a smile and then we go back up to the
eyes because we get so much information about are you interested are you tired are you bored
are you paying attention am i talking too much am i talking too fast all those things you
will signal with your eyes then i'll also look around a little bit just to get a general feel
i might look down at your hands to see if you're brandishing a weapon and then i'll go back up to
the eyes and so as humans we are constantly communicating with our eyes and if you're not
careful with surgery in this area you can send the wrong message you can look if you can look
scary you can look scary you can look angry and it's the same with the with the um the botox
treatments or the the neurotoxin treatments that you might use you don't want to lose your identity
when you have surgery you want to be you just a more restored version of you we often combine the
brow and the lid surgery so when we do surgery we would consider lifting the lid and considering the
lifting the brow as well which is something called an extended barefoot plasti there is
a muscle that opens and closes our eyelid so every time we we blink and close our eyes we use
a muscle underneath called the levator muscle and that's the one that can be weak and cause the lid
to drop down so when we want to do a lid lifting procedure that involves the muscle we usually
make a little cut where our natural creases so that there is no visible scar at the end of it
so the opening is in our skin crease we find the muscle underneath and we tighten that muscle
it's better when you're having lid surgery to be awake because then we can make sure
that you're going to end up with lids that are in the right position for you
so that was the anterior approach to this thing called ptosis surgery lid surgery but you can
also go in from behind because as it turns out there are actually two muscles getting
a bit sciencey again but there are two muscles that lift the lid and one of them is excitingly
under volunteer control so i can you know lift the lid or if i want to look up for example
and there's one under involuntary control which is the one that if you get scared or frightened it's
under a nervous control that you can't control and your eyes will open up because the second
muscle which you can't control acts with under the influence of adrenaline and noradrenaline
and that's also why there are certain topical treatments if you don't want to have surgery
you can actually put some pharmacological drops something called alpha agonists in the
eye and that will diffuse onto that muscle and stimulate it and it'll raise your eyelid just
about a millimeter a millimeter and a half and if you've got a little bit of asymmetry that might be
all you want for a night out the problem is that sometimes it can also cause the pupil to dilate
on one side compared to the other so and it can make your eye very red as well and it's
in long-term use but but basically putting these so that there are pharmacological options i think
we had one of the questions come through saying that um could you use something like timolol
which is a beta blocker to raise the lid and that's that's not quite right because that
actually blocks that system what we're talking about now is something called an alpha agonist
rather than being a beta blocker it's an alpha agonist but that is another way of of raising
the lid but it's not a long-term solution it's just a so your audience might know about these
drops because sometimes they are used if uh for instance um a botox that has strayed a little bit
too far away from where it should have been given causes the eyelid to drop down and you can use the
alpha agonist to actually lift the lid up as part of the treatment before the botox wears off but
it's not something that you want in the long term it also affects the pressure inside the eye these
are actually glaucoma medications so pressure inside the eye problem medication so it's not
something we would say oh use this instead this is very safe standard surgery that we do all the time
so i love the idea of using something like just a drop just before you go out if you want to make
your and it's more symmetrical yeah i mean that there are lots of so yeah this is exciting perhaps
but the your the roman women uh 2000 years ago are were already on to you sarah because
uh there's a plant called the belladonna and the belladonna plant uh contains a substance called
atropine and atropine actually dilates the pupil and so what uh they used to do when they went down
to their parties is they put a drop in so they'd get these large amazing looking pupils and these
dark seductive eyes and they would look like beautiful women bella donna and that's why the
plant where this drug comes from is called the belladonna the deadly nightshade but it does
mean that their vision's very blurry so everyone looks gorgeous and handsome so that's even better
beer goggles without the beer yeah exactly like that the thing to stress to to your viewers
is that this is such a sensitive area and it takes so little to change the sort of the fine
balance of keeping the eye not too dry and not too wet and i think in in the break before we
were doing a little experiment which you might want to try at home which is if you just stop
blinking and really open your eyes for a bit just as much as you can just keep them open
it only takes me about 10 seconds and then they already start feeling a bit irritated
and i start getting slightly red eyes and they start watering we used to have as kids but um
so who who cannot blink the longest but actually if you open your eyes a bit so that
things start evaporating a bit faster then you'll find that even that slight extra opening is enough
to trigger your eye to say oh i something's not quite right i need protection and your eye
will start watering and that's so important to be aware because if you get things wrong
around the eyes by even just a millimeter that can really affect your quality of life
we joke about it but when we are operating on this area it's it's a very very good operation um and
the downtime is actually not as bad as people think so people think that they're going to walk
out after a blepharoplasty operation for the upper lids with these huge bruises and they can't i mean
the patient we saw this morning thought that she was going to end up looking like a panda and that
just isn't the case and it has this unique ability to really make you look younger so what some of
the fillers and the non-surgical treatments can't do is get rid of the the excess skin and so that's
something where surgery is still because it's such an easy operation so straightforward so
predictable and so safe it means that you can for not for not much risk you can get
a a very much younger appearance so sometimes when we um when we're removing the excess skin
off of the eyelid we can actually tunnel up and actually lift the eyebrow as well from the inside
and we can do a small eyebrow lift and sometimes that's helpful because what can happen is that
it's not the extra skin it's not that you have too much skin here but that the eyebrow has actually
moved down and so it looks like too much skin and so putting the eyebrow back in the right place in
men you don't want to lift too much because it can it can again change you can get a startled look
men should usually have their eyebrows sort of on the on the bone right here the the eye bone
as we've decided to call it but there are some other ways as well and so one thing we
can do is an endoscopic brow lift now this is a much bigger operation and it's it it's a it's a
lot bloodier and it's riskier and you actually make incisions here on the side and here at the
top and you tunnel down along the bone and then attach the um the uh the eyebrow to the periosteum
so to the lining of the bone and that sounds like it's a big operation it takes some time
general anaesthetic quite a lot of bruising there are risks to the function of the muscles
afterwards and disappointingly it doesn't tend to work that long so it's not it's not it's not
an operation i would have because you're investing a lot of money and time and risk and sometimes the
rewards don't follow so it might work for a year or two and then you're right back where you were
when i was training over 10 years ago before i was a consultant then at that time
most of um the plastic surgeons that i worked with were doing endograms
and more and more we're finding that actually the longevity of that procedure doesn't really warrant
the amount of downtime um for that particular procedure and you can get really good results
with approaching the brow from a skin crease so your scar is just here you're not affecting all of
the nerves in this area you're not affecting your hairline and you are maybe two weeks of down time
as opposed to a few days with the blepharoplasty alone but an extended blepharoplasty can improve
the position of the brow as much as an endo brow very often so it's one of the right treatments
the third one is called the direct brow lift and that's where you actually remove an ellipse of
skin which involves a little bit of the um the hair so that you then end up with a scar that's
semi-hidden by the eyebrow that works well in people with particularly bushy eyebrows and
particularly in older people who might have more wrinkles for instance then that that scar high
is well hidden so it's actually even though it sounds like well why would i want to have surgery
directly on the eyebrow if i can you know hide it in a crease often in older people it is actually
a very good procedure and one that we like to do because it is very predictable it lasts forever
and it uh it's again very safe particularly in women and often even in younger women you can have
a there's a one condition which we should just be mindful of when we're operating in this area
and it's called third eye disease people who have you don't have to have a disorder with a thyroid
but if you do you're more likely to have this and it's where you notice that the eyes either get red
uncomfortable or you get extra puffiness just in here because the fat around the eye is becoming
more more voluminous more fluffy and so when you see someone who previously hasn't had
a problem with their their pericular area and suddenly things have changed or it's important
to just keep at the back your mind could this be something else could this be a disease process
there is one thing that i want to ask gigi hadid washida the fox eye look um and lifting the
outer brow and a lot of people have been doing that with with the way they pluck their brows
and the way they use their brow makeup um and it's something that lots of people want to
emulate because it it gives a sort of feline or a fox-like look and a higher outer corner of the eye
so i don't know whether gigi hadid has had any surgery for this i don't know personally who
she's been to see for the treatment but it is something that a lot of people are interested
in i think she's had a brow lift looking at what's going on there is there any way to
achieve that result non-surgically well as as you you would know using your neurotoxins you can get
a lot of lifting of the eyebrow by paralyzing the muscle that squeezes the eye shut and
sometimes that's desirable and sometimes that's not desirable some of us might want that elevated
looks other people might find that that makes you look intimidating what we used to call the
mephisto mask and so um yeah you know you you can lift a lot with toxin yeah it works well
with toxin and she would have had toxin as well i would suggest because one of the things that
happens when we do a brow lift is that we're not working on paralyzing
the muscles or weakening the muscles so if you want a combination of lifting the brow
but also not changing the position of the brow and not bringing the brow down every time you
make an expression then you have to use toxins so i think there's a combination of things there
we can speculate that there's arena a brow lift and some toxin going on there speculate