Cosmetic Procedures for Treatment of Aging Eye

Surgical eye procedures have been done since the 1800’s by oculoplastic surgeons and ophthalmologists, who would perform reconstruction on cancer and trauma patients.  In recent years, we have seen more of an interest in surgically treating the aging eye using advanced techniques such as fat repositioning, which require a higher degree of specialization among a relatively new class of surgeons.

I specialize in treating the aging eye, meaning I don’t do orbital reconstruction from cancer or trauma. In other words; I do the beauty parlor of the eye.

AGING EYE SYMPTOMS

Aging of the eye occurs when there is either too much fat or too much volume loss around the upper or lower part of the eye, or when the individual experiences textural lines around the eyes. Aging of the upper eye occurs when the extra skin of the upper eyelid gets closer to the eyes, which also results in the descent of the forehead.  Other aging symptoms include volume loss that occurs around the eyebrow bone area.  Similar effects can occur with the lower eye when an individual has protruding fat (or “bags”) under their eye or volume loss that results from skeletonization of the orbital rim.

Redundant skin is not usually a big issue on the lower eyelid, but can become a problem for the upper eye. However, pigment changes are more apparent on the lower eyelid, since the upper eyelid remains hidden for the most part unless the individual has their eyes closed.

As people age, their lower eyelid tends to drop.  Normally, the lower part of the eyelid will cut across the iris, or colored part of the eye.  However, during the aging process, the lower eyelid will start to droop, and the white below the iris, also known as the sclera, will begin to show.

The first thing people look at when they meet someone is their eyes, which truly are the gateway to the soul. Those same people would have already made a determinate guess on someone’s age just by looking at that person’s eyes before considering their other facial features.   Big bags and skin hanging down over the eyelashes can add years to a person.

AGING EYE DEMOGRAPHIC

Most people I perform eye surgeries on are between the ages of 40 to 60 because it is usually around this time that they show the indications for the aged eye.  Although it is not as common, people in their mid twenties can show these same indications, and may request the surgery since it prematurely ages them. 

ADVANCEMENTS IN SURGICAL TECHNIQUES

In the early days of this type of procedure, doctors were too aggressive when removing skin and fat from around the eye.  Instead of making them look younger, this would have the opposite effect of making them look older due to volume loss and skeletonization, which would make the patient’s eyes look hollowed out.  The art of this procedure is knowing how much fat to remove in order to find the right balance.

FAT REPOSITIONING VS. FILLERS

Today, more advanced techniques are used for treating the eyelid, the most notable being fat repositioning. This procedure differs from the previous technique of tossing away the fat that is taken from the patient’s body.  It has now become standard to treat the skeletonization of the orbital rim by filling in that area by teasing the bag out of the patient’s eye and draping it over the bone down to the cheek. In effect, we are the addressing the fat that’s causing the bag, but instead of cutting that off, we redrape it over the orbital rim and fill in the skeletonization beneath it.

Sometimes, it will be necessary to use fillers when patients don’t have any available fat to treat their skeletonization.  In the case when surgery is not warranted, I would recommend that the patient be treated within the arena of fillers to put back volume.

Although there have been incredible advancements in recent years, repositioning the fat is still somewhat limited. It’s impossible to totally refurbish the volume loss that most people have through repositioning the fat, especially toward the outside of the eye.  Most procedures will require additional filler to treat the outer half of the orbital rim located toward the ear.  It’s easier to reposition or transpose the fat to the inner half of the orbital rim than the outer half.

The problem with the upper eye is that it’s hard to put volume back in the actual upper eyelid since it’s very unforgiving. It is easy to put volume back on the orbital rim, the brow, and the bony part. However, going down to the skin of the eyelid, which is literally over the eyeball, is difficult and dangerous.

We used to take out a lot of skin and even some muscle underneath.  Today, however, doctors are much more conservative with how much skin they take out and rarely take out any muscle. The only fat that I take out of an upper eyelid is using this little ball of fat that’s right by the nose. We used to take out the fat underneath the whole length of the upper eye. I haven’t done that in a decade or longer because we don’t want to skeletonize the eye.

RECOVERY

Eyelid surgery is usually done with IV sedation, not general anesthesia. Although patients rebound very quickly from surgery, it is still advised that they not schedule any important dates 5 to 7 days after the procedure, as that is the amount of time for the swelling to go down.  I also recommend doing this procedure 4 weeks before any major social occasion such as weddings just in case it takes longer to heal.

CONCLUSION

Although aging of the eye naturally occurs when people reach a certain age, it is also true that genetic factors and luck play an important role.  The eyes are what people notice first when looking at someone’s face. With advanced procedures that allow surgeons to perform with greater precision, it is now possible to take years off of someone’s appearance through the surgical treatment of the aging eye. 

Written by Cosmetic Town Editorial Team based on an exclusive interview provided by Dr. John Joseph in Beverly Hills, CA.