Question: I just turned 50 and my eyes look so tired. What are my options for eyelid rejuvenation? I do not want to look different. I just want to look rested and refreshed.
Answer by Dr. Anita Mandal: There are various ways in which the eyelids age. For an optimal rejuvenation result, the correct cause(s) of eyelid aging should be identified. Your eyelids can age from the following:
- Loosening skin
- Protruding fat
- Hollowing due to volume loss
- Downward effects of gravity on the upper cheek
- Sagging of the eyebrows
In the 30’s and 40’s, patients may begin only to show one of these aging phenomena. By the time we enter our 50s, most patients experience a combination of these processes. Failure to identify all contributing factors may result in an unsatisfying outcome.
Loose skin and bulging fat of the upper lids is treated with a blepharoplasty. A well-hidden incision is made in the natural upper lid crease to remove excess skin and fat. Once the incision is healed, it is not noticeable. Many less experienced surgeons fail to extend the upper lid incision outward to remove the hanging skin of the outer part of the upper eyelid. This can result in a worsening appearance after surgery. For this reason, it is important to seek a Facial Plastic Surgeon who specializes in the face and whose board certification and training is exclusively in the face.
Removal of loose skin in the lower eyelids is achieved through an incision a few millimeters below the eyelash line. Once healed, it is also not readily noticeable. Bulging fat can also be removed through this subciliary incision. However, in patients who only have bulging fat with no excess lower eyelid skin, a transconjunctival blepharoplasty is performed where there is no external skin incision needed. This latter approach also preserves lower eye tone. Dr. Mandal performs most of her upper and lower blepharoplasty in her office surgical suite under local anesthesia.
With age, your eyebrows sag and the eyebrow skin gives the appearance of heavy upper eyelids. In milder cases, neuromodulators such as Botox, Jeuveau, Dysport or Daxxify can give an eyebrow lift. RF microneedling with Infini Genius RF, Morpheus or Ultherapy can be combined with Botox for enhanced results. In more advanced cases, a surgical browlift is recommended.
Hollowing under the eyes is typically treated with injectable fillers. Filler treatment of this area requires a much higher level of skill due to the thin skin of the delicate eyelid area. Choice of filler is important as repeated use of temporary hyaluronic acid fillers like Juvederm, Restylane or RHA can make the lower lid prone to puffiness due to the water-retention properties of these fillers. Most of my patients opt for a biostimulator fillers such as Sculptra or especially Bellafill - the 5-year filler which works by stimulating your body’s own collagen.
In some patients, the cause of lower eyelid hollowing is due to the downward movement of the cheek tissues, resulting in volume loss at the upper cheek. In these cases, injectable filler should be placed in both the lower lid hollow and the upper cheek to restore volume and create a natural, balanced look.
Dr. Anita Mandal is a Board Certified Facial Plastic Surgeon of 26 years and a specialist in the face, eyes and neck, Dr. Anita Mandal’s philosophy is to reverse the signs of aging without making you look different, unnatural or distorted. She believes that after a cosmetic procedure, the patient should appear rested, refreshed, more youthful but look as they are simply aging beautifully on their own without obvious signs of a cosmetic procedure being performed.