The eyes have long been described as a window to the soul and their may be some truth to that often stated expression. But they most certainly convey an impression about our state of tiredness and age and all to frequently people are quick to ask about that tired vs. rested issue. Often (and perhaps appropriately), a person’s eyes are the first feature that we focus on in any type of conversation. As the eyes have such an impact on the impression of our facial appearance, people are understandably concerned about it and that makes treatment of the periorbital area an essential strategy for facial rejuvenation.
But what is it that makes the eyelids and the area around them age? Much of the periorbital aging process is due to skin redundancy or excess. As the tissues around the eye are essentially a sphincter, they open and close frequently. Over time, the thin eyelid tissues get stretched out. This redundancy of the skin of the upper eyelids will begin to appear in the late 30s. Over time, the skin progressively sags and may eventually come to rest on the upper eyelashes by the time patients reach their 60s.
It usually takes a little longer to see changes in the lower eyelid and around the eyes in the crow’s feet area. By the 40s, fourth decade, wrinkles will begin to appear out from the corner of the eye and lower eyelid folds start to become are apparent at rest. It is also around this time that bags or pooches appear on the lower eyelids. These are the result of herniated fat coming out from underneath the eye as the support tissues that hold it in are weakening. This fat, usually with some swelling and fluid retention (greater in the morning) is what makes up those pesky lower eyelid bags. By the 50s and 60s, the excess skin and bags of the lower eyelid can be quite pronounced.
When you combine the changes of both the upper and lower eyelids, the cumulative effect is a very tired and hooded appearance with loss of the once crisp eye appearance. This look may also be accentuated or worsened in appearance if the overlying brows start to fall as well. This will make the amount of excess skin in the upper eyelid look worse.
When you look at the anatomy of the periorbital aging process, one can understand several concepts about improving their appearance. In my Indianapolis plastic surgery practice, I emphasize to potential patients the following points about periorbital rejuvenation. First, think of the eyelids and brow as an overall unit. Treating just one area will not have as significant effect as treating the entire problem. They are all connected and the appearance of one influences the other. This is of particular importance as it related to the upper eyelid and the overlying brow. (blepharoplasty and browlift surgery) Secondly, the primary problem in periorbital aging is skin excess. This must be removed to make any appreciable headway. There really is no non-surgical or minimally invasive treatments that will work. The use of lasers or chemical peels is an adjunct, but not a primary treatment method. Third, the lower eyelid is unique due to fat herniation. The fat must be removed or put back from whence it came. Lastly, maintenance treatments after surgery can help prolong the results. (which are not permanent) Botox and chemical peels are easy and very effective office treatments that provide good maintenance to periorbital rejuvenation surgery.
Dr. Barry Eppley
Indianapolis, Indiana