Background: When a man presents for facial rejuvenation it frequently is driven by someone (or many) telling them they look tired. With enough repeated comments and in looking in the mirror, it eventually becomes evident that they in fact are looking tired. This most commonly is due to changes in the eye area.
A man’s eyelids begin to sag and excess skin and fat develop in both of them. The upper eyelid skin hangs down onto the lashes making them feel heavy and obliterating any evidence of a supratarsal fold. The lower eyelid becomes very puffy and develops a sagging appearance. Dark circles often develop under the eyes which draws extra attention to their changed and aging appearance. Also, the eyebrows may begin to sag and hang below the browbone, creating a ‘hangdog’ or an angry expression. Crow’s feet and other wrinkles develop outside of the actual eyelids.
Blepharoplasty or eyelid surgery is the well known antidote to a man’s aging eyes.While eyelid surgery may seem similar between men and women, there are some subtle and important differences. Men often seek a less obvious and an absolutely natural look compared to women. Eyelid scars are also a major concern, particularly in the lower eyelid as men do not have the option of scar camouflage with cosmetics. (they can use them but usually don’t want to) Men also desire to avoid any periorbital change that would make them look in any way feminine. These include such concerns about too high of an upper eyelid crease/scar, an upward flare to the eyebrow or too tight of a sweep to the tail of the lower eyelid or alteration of the corner of the eye. It is also important to realize that men are not usually interested in getting rid of every single wrinkle around \their eyes, they just want to less less tired and more refreshed.
Case Study: This 52 year-old man from Indianapolis Indiana was tired of being told he looked tired. He was bothered by skin that hung down onto his upper eyelids and eyelashes and the bags under his eyes. His lower eyelid bags were usually fairly swollen in the morning and it took all day until some of the puffiness went down. It took him several years to come to the realization that surgery was the answer.
Under general anesthesia, he had both upper and lower eyelids treated. The excess skin of the upper eyelid was removed creating a visible supratarsal fold and upper eyelid crease. A skin-muscle flap lower blepahroplasty technique was used removing a significant amount of herniated fat. Minimal lower eyelid skin was removed and the corner of the eye was tightened with the skin closure.
He had the usual amount of swelling and bruising after surgery that took about ten days to look ‘passable’. By three weeks after surgery, he looked non-surgical and was clearly in the benefits phase of the procedure. He did have some mild tearing issues of the left eye which took six weeks to completely resolve due to a slight amount of temporary lower eyelid retraction in the corner. He ended up with a less tired look around his eyes but with an unchanged appearance.
Case Highlights:
1) Facial aging in men disproportionately affects the eye area with extra skin, protruding fat, wrinkles and brow sagging.
2) Blepharoplasty surgery in men must avoid overresection and tightening of eyelid tissues that can look unnatural and more feminine.
3) Eyelid surgery in men creates a refreshed look but an overall unchanged facial appearance.
Dr. Barry Eppley
Indianapolis, Indiana