When the lower eyes bag and sag then there are a few things that we, as practitioners, can do to help the problem. Like many other options, these alternatives fall largely into two categories. The first, and most effective, is surgical. The second is less invasive.
The TSLMS is dedicated to providing our members, and to some extent the public, with the highest possible level of education and professional support so that you are prepared to help anyone who walks into your clinic or office doors facing the problem of eyes that they no longer love.
Why the Eyes
The eyes are the window to the soul and they are the feature that most people report finding the most appealing when they are judging beauty. Even in cultures of extreme modesty, the eyes provide a picture of the person under the veil. Our eyes tell the story of our life, our happiness, our sorrows, and hopes. And the lower eyelids are a huge part of that story. It is no wonder then that almost every plastic surgeon has a fairly booming business in correcting and restoring the lower lid – which helps to keep both men and women looking youthful, vibrant, and attractive.
As most of us in the field know, the lower eyelids are actually among the first part of the face that show any sign of age. This is due in large part to a combination of factors. First, the eyelid skin is very thin and delicate – in fact the most delicate on the human body. For this reason, as gravity works with age, it is highly susceptible to sagging. On top of that, many people face genetics that do not have as much firmness in the eye area, and those people who have had sun damage will see even faster signs of aging. That aging process takes the youthfulness and smoothness that goes from the lower lash line out toward the cheeks and hairline and disrupts it. In some cases, bags with fat may show up; in others the descension of the cheeks and eyes leave the rim of the eye flat and exposed, making the eyes look skeleton-like. In other people the changes are more subtle, but still perceptible and interrupt their self image and the image they wish to carry into the world every day.
Lower Lid Surgery
The type of surgery that can help saggy brows, droopy lids, and undereye bags can also help to restore peripheral vision. As reported by the National Institutes of Health:
Blepharoplasty plays a vital role in facial rejuvenation, with direct aesthetic relation to the brow and the cheek. Upper and lower eyelid blepharoplasty are indicated for the treatment of excess skin and/or orbital fat. Preoperative evaluation should include a thorough medical and ophthalmic history, along with a detailed cutaneous and eye examination. Symptoms of preexisting dry eye should be elicited preoperatively, as they directly correlate with postoperative complications. Physical examination should take into account brow position, eyelid ptosis, lower eyelid position, and cheek projection. Blepharoplasty can be performed by many operative approaches… The standard [is] skin-only upper blepharoplasty and lower eyelid conservative fat excision or repositioning.
The American Society of Plastic Surgeons has a fantastic video they have produced that shows what an eyelid surgery actually looks like and what it best accomplishes. As the video describes, the procedures involve a surgery that removes not only the fat deposits under the eye, but also remove skin and sometimes muscle above the eye on the lid. Otherwise referred to as an eye lift, the majority of the patients seeking the procedure are truly concerned about their appearance. However, there are genuinely people you will see who are seeking to treat their vision, and the aesthetics are just a nice additive.
For this first group, seeking to improve their appearance, the less invasive procedures may be a good option. However, in most cases of those looking for peripheral vision restoration it is not.
Less Invasive Procedures for the Lower Lid
There are a number of practitioners who firmly believe in, and promote, alternative treatments to blepharoplasty. These treatments include botulinum toxin and ultherapy.
Botulinum Toxin, as noted by the National Institutes of Health:
is one of the most poisonous biological substances known, is a neurotoxin produced by the bacterium Clostridium botulinum. C. botulinum elaborates eight antigenically distinguishable exotoxins (A, B, C1, C2, D, E, F and G). All serotypes interfere with neural transmission by blocking the release of acetylcholine, the principal neurotransmitter at the neuromuscular junction, causing muscle paralysis. The weakness induced by injection with botulinum toxin A usually lasts about three months. Botulinum toxins now play a very significant role in the management of a wide variety of medical conditions, especially strabismus and focal dystonias, hemifacial spasm, and various spastic movement disorders, headaches, hypersalivation, hyperhidrosis, and some chronic conditions that respond only partially to medical treatment. The list of possible new indications is rapidly expanding. The cosmetological applications include correction of lines, creases and wrinkling all over the face, chin, neck, and chest to dermatological applications such as hyperhidrosis. Injections with botulinum toxin are generally well tolerated and side effects are few.
Skin resurfacing and injectable dermal fillers are two of the other alternatives to eyelid surgery. Many more alternatives exist as well. Much of this will be covered at SCALE 2019 Music City. We look forward to seeing you there.