Tag Archives: Non-Surgical

Eye-opening concepts.

It has been said that the eyes are the windows to our souls. Certainly we often remember our friends and love-ones faces with the eyes playing a prominent role in facial identification. Unfortunately the aging process can strike this region relatively early leading to appearances that project fatigue, disinterest, and lack of vitality. Aging will result in skeletal changes around the eye, shrinkage of muscle and fat volume in the temples causing lateral brow descent, thinning and loss of elasticity of the skin of the eyelids, prominence of the fat pads of the upper and lower lids as a result of a weakening of the eye socket surrounding these structures, and in some cases the muscles that control upper eyelid position stretch or change leading to the upper eyelid drooping with respect to the pupil giving a sleepy appearance. All these symptoms of aging can hide the bright and vibrant person inside giving the false impression of a tired worn out individual. Take back the youthful appearance that is hidden under the veil of aging by consulting a board certified plastic surgeon who has expertise in eyelid and brow rejuvenation.

Brow

As with all anatomic areas deformities of the upper third of the face can span a wide range of severities. Many times women in their late thirties and early forties can show signs of early brow descent which can narrow the opening of the eye and brow skin resting on the upper eyelids. Many times in these milder forms of age and gravity related deformities we can correct with muscle balancing procedures utilizing neurotoxins such as Botox to weaken the depressors of the brow and allow unopposed brow elevators to prevail and elevate the resting tone of the brow.

Another targeted area to correct non-surgically, the brow position, is to restore volume to the temple region of the skull. This area in front of and superior to the ear and lateral to the brow represents the temporal fossa. This houses a large flat muscle that helps to elevate the jaw and is surrounded by soft tissue including fat and covered by hair bearing scalp tissue. Bony and muscle remodeling coupled with overlying fat shrinkage can lead to a hollowed out appearance which causes the brow to fall downward making the brow skin begin to cover the upper eyelid skin. Volume restoration can be accomplished with any number of filler agents but I prefer to correct the volume with a guided tissue regeneration product call Sculptra which is a polymer of lactic acid which promotes collagen deposition over time restoring volume and allowing the brow to be supported at a higher level compared to a depleted state.

As the brow tissue descends lower, further concealing the upper eyelid, the options narrow to surgical intervention. I prefer an endoscopic assisted brow lift over an open approach to avoid scars and hairline shifts. Just a few small openings spread out over the hairline allows for the complete release of the forehead and fixation internally to correct brow drooping leading to a pleasing brow position which looks natural without changing the hairline and allowing for improved visualization of the upper eyelid. In most cases the upper eyelid skin will require modification to give a harmonious smooth result. Errors such as trying to remove excess upper eyelid skin which includes excess brow tissue instead of performing a simultaneous brow lift will result in a poor result with very high eyelid crease scaring and the inability to close the eyelids resulting in dry eyes. Expertise in the aesthetic and functional evaluation of the upper third of the face is important.

Upper eyelid

The most common cause of excess upper eyelid skin is the underlying result of periodic eyelid swell causing excess thinning tissue. This can be addressed with conservative blepharoplasty techniques which can include some judicious fat removal. Of course a thorough exam to determine if the resting eyelid position with respect to the pupil is too low because not correcting the drooping of the upper lid will give a less than adequate rejuvenation because the patients eyes will still seem tired due to the lid lag.

Lower eyelid

Common aesthetic problems of the lower eyelid include excess skin, lack of lateral support of the lower eyelid giving a rounded eye appearance and excessive show of the whites of the eye ball, large fat pads with or without loose skin, increased separation of the eyelid cheek junction, and lastly crow’s feet. If skin quality is reasonable without excessive crepey skin and there is increase separation of the eyelid cheek junction then a conservative injection of a hyaluronic acid placed on the cheek bone under the muscle that closes the eyelids can smooth out the tear trough as well as build up the lateral eyesocket boney rim hiding some mild bulging of the lateral lower fat pad of the eyelid. This can create a Photoshop effect smoothing out the eyelid. Another conservative approach to helping the aging lower eyelid is to diminish activity of the lateral muscle that closes the eyelids with neurotoxins which can lead to a reduction in crow’s feet and can slightly help to elevate the lateral third of the brow.

Surgical interventions of the lower eyelid include judicious removal of the two lower eyelid fat pads through the inside of the lid with transposition of the fat on to the cheek to hide the tear trough, surgically removing excess skin from under the lash line vs skin tightening with a C02 Laser, lateral lid support to the bone enhancements with or without shortening the horizontal length of the lid. These procedures need to be selected based on clinical exam with the goal to provide a youthful eyelid with good support while avoiding excessive hollowing of the lower eyelids and poor lid support leading to rounded eyes and increased exposure of the eyeball.

The upper third of the face contains the aesthetic units of the brow, upper and lower eyelids and are a very unique region of our body for both special senses of vision, and provide our unique individuality of facial appearance. Aging can have a detrimental effect on both the aesthetics and function of this region which can bias people’s opinion of our vitality and mental sharpness. Non-surgical and surgical corrections can be important tools to correct these deformities restoring our appearance and giving back self confidence.

Look as good as you feel in 2016

So you work out, eat smartly and watch your calorie consumption but your face looks tired, and you look older than you feel. Trust me, you’re not alone. The good news is something can be done that is predictable and sustainable to make you look and feel better about your face.

The key to success is a thoughtful facial analysis, which evaluates your bone structure, muscle activity, soft tissue volume, skin quality and the position of your forehead, brows, eyelids, cheeks and neck. I approach a patient’s face much like an engineer with a sculptor’s artistic eye. I create a problem set followed by a detailed treatment plan, tailored to each of my patient’s wishes and financial parameters.

Treatment plans often include skin quality improvement with techniques such as serial chemical peels and micro-needling. Please see previous blogs on these therapies on my website. If excessive muscle activity leads to a harsh appearing forehead and brows, muscle modulation with Botox can be an excellent approach.

Looking at the upper third of the face, I evaluate brow position with respect to the bony orbital rim and its relationship with the upper and lower eyelids. On women you want the brow to be above the orbital rim with the outer third being elevated compared to the inner 2/3 of the brow. Heavy hanging brows make the eye aperture appear small and tired.

Another important factor in evaluating the upper eyelids is eyelid ptosis (the muscle mechanism which elevates and maintains resting tone of the upper lids). Eyelid ptosis must be addressed with the blepharoplasty to prevent a tired sleepy appearance despite correcting the fat pads and excess skin.

The lower eyelids must be evaluated carefully in comparison to the bony anatomy surrounding the eye and the supporting structure of the lateral canthus, which anchors the eyelids to the lateral bony orbit. Great care must be taken if you have a prominent eye compared to your cheeks and have deficient lower eyelid vertical skin coverage. Weak lateral canthi can result in disastrous results with excessive eye exposure leading to pain and visual disturbance.

Finally, the lower eyelid cheek junction must be inspected. A large tear trough and bulging fat pads can detract from a youthful appearance. Taking out too much fat can result in a hollow eyelid, which can actually create an even older appearance. Current techniques include judicious removal of some of the fat and then actually transposing the fat pad down onto the cheek mass obscuring the demarcation and giving volume to the cheek and avoiding a hollow look.

The midface is all about volume. As we age, the cheek fat pad shrinks in size leading to the face falling with accentuation of the nasolabial folds. In most cases midface restoration can be corrected with volume-added techniques of either fat or filler agents making tissue repositioning in this area less important. A non-invasive injection of Voluma can be a great treatment option.

The lower facial third and neck are evaluated with regard to the jaw line, chin neck angle, and the draping of the soft tissues including the skin and neck muscles. Younger people with good skin quality may well be treated with liposuction alone to achieve a pleasing neck line. If the lower jaw is small with respect to the rest of the face, a chin implant or chin repositioning may help your neck appearance, in addition to liposuction to improve results and create harmony with the lower facial third compared to the rest of the face.

Older skin, with bands of the platysma muscle showing through, is less compliant and is best treated with a neck lift procedure. This surgery includes fat equilibration, neck muscle tightening and soft tissue repositioning and stabilization around the ears.

Facial rejuvenation is not painful, although swelling and bruising will occur. After the dust settles, results can be natural and youthful in appearance with long-lasting results that will boost your confidence beyond any wardrobe or hair makeover.

Look as good as you feel in 2016. Happy New Year!

Collagen Induction Therapy

Your skin has a challenging job. From environmental factors to hormonal changes, it bears and reflects the brunt of life’s shifts. Thankfully, your skin has two support systems – collagen and elastin. Skin loses its natural elasticity as we age, but we can turn to other sources of support like injectables. We mentioned in a previous blog that Botox is an option. Another skin rejuvenation method has also created some recent buzz.

Collagen induction therapy, also called microneedling, is an effective way to enhance your skin’s look and feel. This minimally invasive procedure uses tiny punctures to induce a collagen and elastin response from your body. This helps with skin texture and firmness and reduces scars, pore size and stretch marks.

We are proud to offer collagen induction therapy at The Lucas Center. Call us today at (865) 218 – 6210 to schedule a consultation. Let us help you put the “bounce” back into your skin!