In a Season of Sunglasses: Rejuvenation for Your Eyes

I always find it fascinating how much expression can be conveyed by one’s eyes. My kids were trying to guess each other’s emotions behind a mask today, and it ended up being easy for them to tell, by their siblings’ eyes, whether they were smiling or serious.  Of all the features of the face, the eyes are most emotive.

Socially, we also tend to focus on eyes as reflecting one’s state of being. When we subconsciously assess the personality and vitality of another person, many of the cues we take in are around the eyes. We see frown lines between the eyebrows and assume anger, frown lines in the forehead and assume anxiety, bags under the eyes and assume fatigue and a lack of energy.

While we may focus in the mirror on the appearance of various wrinkles and redundant skin in the lower face and neck, this isn’t where the money is, so to speak, in terms of looking our age. While skin quality is a critical element of facial appearance, the cues we receive about a person’s age are actually largely tied to the appearance of the eyes and surrounding tissues.

The aging process around the eyes is both obvious in some ways and subtle in others. What we tend to be able to name and put a measure on is the various wrinkles that develop around the eyes, wrinkles that are even popularly referred in their separate locations by names such as “crow’s feet,” “bunny lines,” and “11’s” or “frown lines.” These lines are a result of wear and tear – the facial muscles that power a smile and a frown eventually wear down the smooth, bendable skin overlying that muscle, and create a permanent fold in the skin around the eyes. It is also fairly easy to see when the thin skin of the eyelids has lost some elasticity. This extra skin can blur the crisp definition of the eyelids and result in a tired appearance.

There are also more subtle factors at work. What is commonly referred to as “bags” under the eyes represents a combination of stretching and tethering of the underlying tissue, resorption of the malar bone and loss of fat in the adjoining medial cheek area. The lower eyelid can lose elasticity and become more round in appearance, exposing the white sclera beneath the iris. The position of the lateral brow can also drop with age, leading to a flattened or quizzical shape to the brows.  In advanced cases, a low brow position combined with excess upper eyelid skin results in loss of peripheral vision. Efforts to improve this “blind spot” by raising the eyebrows can create symptoms such as muscle strain and fatigue as well as headache.

For early changes, minimally invasive treatments including Botox and fillers can be used to smooth lines and hollows, as well as reshape the brows. For other situations, a combination of surgery and minimally invasive treatments is optimal.

Surgery for the periorbital area can help create a more rested and alert appearance to the whole face. Upper eyelid surgery can address excess skin and fine wrinkles of the upper lid, can address excess fatty deposits that appear as puffiness in the upper lids, and can create better definition of the eyelid fold. Lower eyelid surgery can correct bags under the eyes, correct malposition of the lower eyelids, and address excess skin and fine wrinkles of the lower eyelid. Also known as a forehead lift, a brow lift lifts and shapes the eyebrows to a more youthful appearance, and minimizes creases and “frown lines” that develop across the forehead and glabellar areas. Often a combination of treatments is optimal in order to give a more natural appearance.

If you notice some of these changes and are interested in learning more, the first step is to have a full facial evaluation by a board certified plastic surgeon. This physician can determine the factors in each individual that are contributing to aging changes around the eyes, whether it be muscle activity, loss of skin elasticity, the underlying bone structure of the face, or loss of soft tissue support and volume. From there, plastic surgeons have a full armamentarium of tools at their disposal in addressing these issues. Rather than simple line or wrinkle correction, the goal is an individual treatment plan that focuses on harmony of features and a three-dimensional periorbital rejuvenation. A detailed understanding of the causes, as well as the spectrum of agents and techniques available today enables plastic surgeons to provide truly individualized and reliable care.