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Around Eyes Rejuvenation

The area around the eyes are called periorbital regions. The old techniques to rejuvenate these areas included cutting techniques  such as blepheroplasties and brow lifts. But these techniques had never given any satisfactory results.

These areas are the first to be affected with ageing. Drooping of the eye lids can be seen in women around the are of 35 and sometimes even earlier. As people age the eyelids starts drooping more resulting in smaller appearing eyes.  Ageing also causes excess skin in the upper or lower eyelid. This is termed Dermatochalasis. 

Above picture shows deepening of the nasojugal crease number 3

The traditional approach to rejuvenate these areas was to do a blepheroplasty for upper and lower eyelids. But most people only looked older and their faces got more skeletonized with these surgeries.  But now we know the best way to rejuvenate these areas are with fat grafting. The fat is obtained by liposuction with the tumescent local anesthesia and then cleaned by centrifugation. The cleaned fat can be injected into the forehead and area around the eyes to rejuvenate these areas and obtain a younger looking face. Fat grafting can correct all the changes which occur in the area around the eyes with ageing. These changes include drooping of the eye lids which occur with aging. In fact some people notice that their eyes close slowly as they age. They have to make an attempt to keep their eyes fully open. With the forehead fat graft this condition can be corrected. Deepening of the nasojugal fold or the line under the eye is one of the earliest sign of ageing. Some people call this condition eye bags.

Another change which occur is lowering of the eye lids and retraction of the eye lid due to the loss of the fat pad under the eye brows. This also leads to some loss of eye brows.

Above photo shows fullness of the upper and lower lids in two models. As aging progresses you can note that showing of the white part of the eye below the cornea of the eyes. (Scleral Show) and prominent tear trough line.

Scleral show and prominent tear trough line can be seen above. Further changes of aging include deepening of the nasolabial fold and retrusion of the cheeks.  The soft tissue volume loss as well as maxillary bone hypoplasia both can contribute to this. The older surgeries included endoscopic, coronal, trichophytic, transblepheroplasty, mid-forehead crease, temporal and direct brow lifts. Brow lifting procedures often change a patients appearance resulting in an unnatural look. The patient looks constantly surprised. With a patient with deep set eyes the brow lifting can accentuate the supraorbital rim resulting in an emaciated look.

Lower eye lid blepheroplasty here results in slceral show, ectropion, and anterior lamellar shortening.

Post upper and lower lid blepheroplasty with brow lift causing high eyelid crease, overly elevated brows and volume loss over the superior orbital rim.  However, this approach often resulted in hollowness of the eye area and an unnatural "cat-like" look in the corner of the eyes. Latest approach to obtaining the youthful and beautiful upper face is fat grafting (with patients own stem cells) and combination laser treatments.

Volume loss around the lower eye lid occurs due to atrophy of the malar fat pad and subobicularis oculi fat (SOOF) which results in concavity (Sunkenness) in this region. This is often accompanied by darkness and further pigmentation in this area. (Called dark circles). Sometimes with volume loss blood vessels appear in this region. Fat grafting and volume regeneration brings the youthful appearance and helps to remove sunken eyes, dark circles and blood vessels.

Now the significance of volume loss on aging face is well recognized. A good surgeon starts by evaluating the photos of the patients taken several years earlier.  Another important fact which goes unrecognized is that position of the row does not change with ageing. Only the volume depletion of all the structures around the eye. The picture below shows before and after fat rejuvenation around the eye and rest of the face as well.  The restoration of beauty with volume repletion is quite remarkable. There is no better way to rejuvenate the face than a properly done fat graft with an experienced cosmetic surgeon.

Abvoe photo shows about 20 years younger face on the right side which was accomplished with fat grafting for the entire face.

The eyes play an essential role in facial attractiveness and beauty and should be surrounded by high walls, similar to the principle of utilizing frames for pictures on a wall. Higher walls allow for greater projection of the eyebrow, correlates to a greater degree of perceived facial attractiveness. We make a great effort to improve the projection of eye brows in our fat grafting to the face.

Above is a good example of going from pretty to spectacular with fat grafting technique