Thank you for your question.
You submitted your question without a photo but you’re asking, what is the best long
lasting treatment to help sagging eyelids and crow’s feet lines. And you elaborate
further in your question that you notice that one eye is more droopy than the other and
that you’re noticing crow’s feet lines that are extending into the cheeks.
Well, I can certainly share with you my general approach that hopefully will be useful to
you when you decide to meet with doctors about your situation. A little bit of background,
I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and
reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years.
Helping people with drooping eyelids and crow’s feet lines and eye and facial aesthetics particularly
in the arena of facial aging has been a core of my practice of over 20 years.
When I look at a patient who complains to have similar situations like what you are
describing, I do the following: I look at things in a systematic way. First, when you
say that one eye is drooping more than the other, you want to distinguish is there excess
skin and that term is called dermatochalasis or is there ptosis. Ptosis which means drooping
of the eyelid margin which means the relative position of the eyelid to the center of the
pupil is lower or is it a combination of both. So a proper eye evaluation will determine
whether there is excess skin or drooping of the eyelid, dermatochalasis versus ptosis.
It’s also important to look at the eyebrow position. The eyebrow can descend with age
and often there is a certain contribution on extra skin or drooping from the eyebrow.
So that’s just one part of the upper eyelid question.
When it comes to the procedure that is longest lasting, you’re basically talking about
a procedure such as cosmetic upper eyelid blepharoplasty. Cosmetic upper eyelid blepharoplasty
means that essentially what we’re doing is we’re artfully creating a natural shape
that involves removal of extra skin and soft tissue as well as possibly fat that is contributing
to that drooping heavy appearance. If there is a presence of ptosis, well that is a little
bit more technically demanding. This is a procedure called ptosis repair where the muscle
that lifts the eyelid called the levator muscle is addressed and the eyelid is allowed to
open further.
Again, I can’t overstate it because it is frequently missed that you have to be able
to identify and distinguish what is causing the drooping of the eyelid. There are times
when patients come who have had upper eyelid blepharoplasty and they still feel that their
eyes aren't that open and it’s because they still have ptosis. So not missing ptosis is
very important.
The art of upper eyelid surgery is that it should look very nice and natural. And I think
that a lot of people are very afraid of an over operated look. And this speaks to really
the individual style of the doctor you choose and therefore it’s important to look at
that doctor’s before and afters to get a sense of what their style is. My own personal
approach is I like to retain a character to the person’s face. And so, when I do upper
eyelid blepharoplasty, my goal is to really show off the patient’s natural eye shape.
It’s not just about removal of extra skin. We have had patients come who were very unhappy
with eyelid surgery done elsewhere because they had the skin removed but the true shape
of their eye and the character of their shape now is not the same as what they had hoped
it would be. And basically, they don't feel like they’re looking at themselves and they’re
very uncomfortable with that. So good planning and an artistic approach is very important.
Now this surgery is done in our practice under local anesthesia with LITE™ sedation. This
means that you’re not put under general anesthesia. It’s done in our office operating
facility which a lot of our patients find attractive because they don't have to go to
a hospital or surgery center. And most people go back to work in a week.
Now as far as the question about crow’s feet lines, it’s a different type of strategy
in terms of long lasting. When you look at crow’s feet lines, you have to look at two
different variables. One is the activity which means how much are they pronounced when you
smile when you’re active and these are called dynamic wrinkles. And then there are the lines
that are there at rest and those are called static wrinkles.
There’s usually a dual approach in our practice. What I do is I recommend a neurotoxin such
as Botox® or Dysport to relax those muscles
and that can last anywhere from 3 to 6 months so there isn't this constant compression.
And in certain candidates, we can consider everything from lasers to radiofrequency as
well as platelet-rich plasma (PRP) from your own blood to stimulate collagen and also softer
fillers. There are definitely a lot of ways to treat the static lines, the lines that
are there at rest and that combination is usually very successful.
But in terms of long lasting, there’s always some kind of maintenance involved because
really, what you’re dealing with is a dynamic process, muscles moving, normal facial aging
and you’re dealing with skin quality. So typically, a patient will come in for Botox®
every 4 months or so, they’ll come in for PRP injections once every 6 months. As far
as the lasers are concerned, usually one laser is good for many years but it depends on the
type of lasers. There are a lot of different options. There’s non-ablative, there’s
ablative. And so, this is more individualized and that’s based on a physical examination.
So I recommend that you meet with qualified, experienced cosmetic surgeons who work extensively
in the eye area. Look at their results, look at their style and see if you are able to
click and work well with the doctor that you meet with.
So I hope that was helpful, I wish you the best of luck and thank you for your question.