I'm 39 yrs old and I had depressions under my eyes for as long as I can remember.
Any suggestions?
What procedures would be the most effective in rejuvenating my upper and lower eyes?
Thank you for your question!
Your 39 years old and you submitted two photos: one close-ups of your eye and forehead area.
One with your eyes relaxed, one with smiling.
And you’re asking about what to do with your upper and lower eyelids.
And you also mentioned that you have depressions under your eyes.
Looking at your photos, I can just share with you the approach we have in our practice and
how we discuss eyelid rejuvenation when people come to our practice.
I’m a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for
over 20 years and this is pretty much what we do every day.
I’ll tell you that there are few things that you should look at besides looking at
the close-up of your eyes.
I’m also boarded in general cosmetic surgery including in face, body, breast and extremity
and I also do a lot of facelifts.
So we kind of look at the eyes from not only the perspective as a specialist in eyes but
also as a specialist in facial rejuvenation.
And the reason why I’m saying that is that when you look at yourself and you’re bothered
by the appearance of your eyes, sometimes you get so focused in this area that you missed
the details of the rest of the face that contribute to the overall appearance.
So, when I look at someone’s eyes, I also look at the mid face where we refer to as
the submalar or the cheek area and you look at the eyelid and cheek junction.
Now why is that?
Well paradoxically, not only do you see puffiness under the eyes but you also see volume loss
in the cheek area.
So, with that being said, let’s just analyze the appearance of your eyes.
The upper eyelids appear to have some extra skin, some fine wrinkling in this area and
the lower eyelids appear to have some puffiness and fine wrinkling of the skin and of course,
more wrinkling when there is muscle activity such as smiling like when you show in your
photo.
In our practice, it is routine to perform something called an upper eyelid blepharoplasty
for the upper eyelids and this is to reduce the excess amount of the skin sometimes also
sculpt the fat that’s underneath the eyelid skin, the orbital fat and the sub-brow fat
and do a nice closure to minimize the upper eyelid incision and allow for a natural appearance
and rejuvenation.
Hooded upper eyelids tend to make people look sad and tired.
It basically dominates the intrinsic natural shape of the eyes and so no matter how nice
the eyes have a shape, the hooding actually look tired so it can be quite dramatic at
the same time look very natural.
With the lower eyelids, you have what we call lower eyelid fat prolapse.
Lower eyelid fat prolapse means that the fat that’s normally around your eyes, it pushes
forward and creates a hernia and creates puffiness.
In reference to your common about depressions, if you think about it, when there is a relative
depression, one that is already there, something that you are aware of, when there’s volume
adjacent to it, it’s like a mountain next to a valley and makes the valley look deeper.
So I would suggest that, in addressing the mountain, what we would perform is a lower
eyelid blepharoplasty.
Now there are two ways to do a lower eyelid blepharoplasty: one is from the outside called
a transcutaneous blepharoplasty which means making an incision underneath the eyelashes.
In our practice, we do something a little bit different for most of our patients is
called transconjunctival blepharoplasty.
This is an approach of doing the procedure from the inside of the eyelids.
From my personal experience, although I can certainly do all these procedure and much
more advanced procedures, I like doing the transconjunctival blepharoplasty because it
tends to retain the natural shape of the eye very nicely.
It allows for preservation of the lower eyelid support structure, the orbicularis oculi muscle
and the tendons and everything else.
As a specialist, I’m called by a lot of patients from all over the world to revise
lower eyelid position and problems because the lower eyelids are deceptively complex.
There are several key structures that are necessary to be in balance in order for the
lower eyelid to retain a nice eye shape.
A lot of times, people have something called a lower eyelid retraction or ectropion where
the eyelid actually everts away and they come for revision surgery.
So when I do this procedure, I address the herniated fat or the prolapse that pushes
out and creates those bulges from the inside of the eyelid and then when we are dealing
with fine lines and wrinkles, we actually do two methods: we use fractional CO2 laser
which is a laser which combines an ablation or removal of the top laser of the skin as
well as generation of the top layer of the skin as well as generation of thermal energy
into the dermis, the backbone of the skin, to create tightening.
We also use regenerative medicine technology which is called platelet-rich plasma.
Platelet-rich plasma is derived from your own blood and it’s basically using the same
technology which is also being applied in orthopedics for joints and wound healing and
applying it to the skin to stimulate new collagen, blood supply and improvement of skin quality.
In conjunction with fractional CO2 laser, we are really pleased with those results.
Now during my consultations, I always point out to my patients how the volume in the cheek
area, where it is prior to the surgery, people will be concerned about potential hollowing
after this type of surgery.
And it’s not so much about taking so much fat under the eyes, it’s actually about
they didn’t realize that there was volume loss in the cheeks.
Although the negative of the eyes was reduced, they look better, they then focus on the volume
loss in the cheek and wonder why that wasn’t pulled up with eyelid surgery.
Frankly, it’s not practical.
It’s not realistic to pull up this volume and because there’s an absence of volume,
even a mid face lifting procedure may not be adequate because there’s a volumetric
loss.
I always describe that the cheek volume in the face with aging changes kind of like the
breast volume does with the aging with the upper pole of the breast diminishes and the
size of the breast diminishes combined with descent.
So there is reality of facial aging where this both volume loss and descent or sagging.
So a game plan for you is to do, what a lot of our patients do which is address the negatives:
the extra skin above the eyes, the puffiness under the eyes, the fine lines and wrinkles,
be aware of the volume in the midface and either chose to do something during the procedure
and options such as fat transfer, submalar implant or injectable such as Radiesse, Restylane
or any hyaluronic acids and try to balance that out so that you do a lot of things at
the same time.
Other options, do it afterwards but understanding globally what your appearance is prior to
surgery and then coming up with a plan afterwards is usually a good strategy from the word go.
I suggest that you meet with qualified experienced cosmetic surgeons who have a lot of experience
with eyelid surgery.
I really strongly believe in extensive experience in any area in cosmetic surgery.
I think that it always allows patients to have a more predictable result and when a
doctor has a specialization and the experience in the specialization, then it’s a matter
of matching the patients aesthetics and the surgeons aesthetics to get the desired results.
So I hope that was helpful, I wish you the best of luck and thank you for your question!