Eyelids surgery - 31 years old?
I am very dissatisfied with the state of my skin around eyes - tired look, lots of wrinkles,
saggy skin.
I am 31 years old.
Is upper and lower blepharoplasty recommended?
All other facial skin (except one around eyes) is perfect, no wrinkles.
Thank you for your question!
You're 31 years old and you're concerned about the appearance of fine line and wrinkles under
your eyes and you're asking if blepharoplasty is an option.
Well, as an oculoplastic cosmetic and reconstructive surgeon, I deal these type of concerns everyday
in my practice.
So I can share with you a little bit of my approach of how I counsel my patients.
First, you have to understand that wrinkles and excess skin are not always synonymous.
In fact, blepharoplasty, a surgical procedure, defined by removal of extra skin, addressing
fat pockets, puffy bags under the eyes as well as over the eyes, will not make a significant
improvement when you're dealing with the textural quality of skin.
So when I look at a patient, I look at a couple of things.
First is their age and skin type.
It's very well established that people who are Caucasian, lighter skin, for example irish
descent, will have more accelerated aging of the skin manifested as fine lines and wrinkles
compared to age-matched African-American skin type.
So that's one part of the equation, the genetics.
Then, when we look at the causes of wrinkles in addition to genetics, we think about what's
going on in the inside of the body as well as what's going on in the outside.
So let me explain.
When you for example, smoke, smoking will cause wrinkles to accelerate and it is well
established in the cosmetic surgery literature that fine lines, wrinkles, photoaging or aging
or I should say will be accelerated by smoking whether it's from carbon monoxide generation
or generation of free radicals and other cell wall damaging of smoking.
So if you do smoke, consider stopping.
Think about the environment.
The sun exposure is so much more of a factor in photoaging and that's why it's called photoaging,
it's sun-related, light-related aging.
If you spend a lot of time in the sun or you live in a place where there's incidental sun
exposure, then you have to be mindful of always wearing sunblock and avoiding the sun as much
as you can within reason.
So, let's talk about the interventions that we can help people to address the fine lines
and wrinkles under the eye.
First, let's talk about the activity of the muscles.
The photo you submitted, it appears that you are squinting a little bit or you're smiling.
So the wrinkles that are generated from that is called dynamic wrinkles.
Dynamic wrinkles means that a muscle is activated and those wrinkles appears.
So how do we manage dynamic wrinkles?
Well, we manage using materials such as botox or dysport.
These are what we call neurotoxins that are injected directly into the muscle in a very
specific way to minimize the activity of those muscles so that those wrinkles would less
likely to form.
Not only does the residual activity of the muscle diminish, when you think about paper
being creased over and over, then you can appreciate that by reducing the activity,
those lines become less pronounced.
Now, when the wrinkles are present at rest, those are called static wrinkles.
Now these are the wrinkles that are around the eye, like crisscross wrinkles or the fine
lines that parallel the muscle around the eye called the orbicularis oculi muscle.
For treating those lines, we have several options.
Some involve lasers such as a fractional cO2 laser.
And with lasers, we're applying thermal energy in a very specific way to tighten the skin
and to resurface the top layers of the skin.
It doesn't eliminate wrinkles.
It improves the appearance of the lines.
And something else that we do and I think that is slowly becoming well known is the
use of platelet-rich plasma.
Platelet-rich plasma is derived from your own blood and it is the concentration of the
healing aspects of the blood called the platelets which with the plasma contain growth factors
and something called vascular endothelial growth factor which is factor that helps stimulate
blood supply.
All of that has been shown in our practice to significantly enhance skin quality.
And when you think of it in a scientific perspective, aging of skin, there are changes in the collagen
makeup as well as the blood supply and the vascularity.
And so interestingly, platelet-rich plasma seems to have a reversing effect up to a point.
But ultimately, there's better skin quality, there's better glow.
The skin under the eyes in only a half millimeter thickness.
So there are limitations on what kind of fillers or other options you have.
So, conceptually, you will be someone we manage in a combination approach.
A not surgical approach but a non-surgical strategy which includes neurotoxin like botox
or dysport, thermal energy such as fractional cO2 laser and regeneration using platelet-rich
plasma.
So although that cannot stop everything or reverse anything, I think it can make a very
significant impact in helping you look your best as you get older.
So I hope that was helpful and thank you for your question.