Solution to Tired Eyes Part 1

A Blog about the Cause of Tired Eyes by Dr. Loftus

Many women come to us complaining of tired-looking eyes and requesting eyelid lifts. Many changes occur around the eyes as we age. In this blog we discuss what happens. In part two, we discuss what an eyelid lift (blepharoplasty) can do about it.

In "Let’s Face It" we discussed facial aging, focusing on the face as a whole. We did not discuss the specific changes around the eyes. As you know from "Let's Face It", skin thins as we age. Nowhere is this more apparent than around the eyes where the skin becomes papery and wrinkled. It also loses elasticity, stretches and deflates from fat volume loss. This leads to excess skin.

Eyelid Wrinkles

"Static" wrinkles form from redundant, deflated skin. Another category of wrinkles is created from repeated muscle contractions when you smile, squint and close your eyes. These are called "dynamic" wrinkles. Dynamic wrinkles are analogous to folding a piece of paper over and over in the same place. Eventually the paper weakens along that line and a permanent crease results. These lines are often called "smile lines," "laugh lines," or "crow’s feet." Botox is great for these.

Eyebrow Droop

The excess skin on your upper eyelids is magnified by your descending brow. As the brow droops with age, it pushes more skin onto your upper eyelids. This makes the upper eyelids more droopy in appearance. Further, your brow becomes flatter in appearance, losing the feminine arch and looking more stern and masculine. We will talk more about this when we address brow lifts in depth.

Sunken Eyes

The eyeball normally sits in the eye socket surrounded by pockets of fat. This fat is in little pockets to keep it in place. Some of this fat atrophies (withers away) as you age. Less fat, combined with weakening of the connective tissues that support the eye cause the eyes to sink into the eye sockets slightly.

Bags Under the Eyes

Some of the fat around the eyes begins to bulge. Tissues in the lower eyelid normally hold this fat back like water behind a dam. These tissues weaken and allow the fat to puff out. As the cheek fat volume descends (as we discussed in "Let’s Face It," it leaves an absence of volume at the lower eyelid-cheek junction. This exposes the pockets of fat that are present under the eye for padding the globe. These changes magnify the appearance of bags and protruding fat in the lower eyelid. The lower edge of the eye socket bone is sometimes visible through the thinned skin, leaving a curved crease. This curved depression that forms at the lower border of the lower eyelid is often called a "tear trough."

Rounded Eye Shape

Finally, the shape of your eyes changes as well. Youthful eyes are almond shaped with a slight upward tilt towards the outer edge of the eye opening. This youthful shape is dependent on the lower eyelid’s attachments to the eye socket on each end. It is suspended by a band of tissue that replicates a clothesline. The lower eyelid hangs on it like a sheet. This "clothesline" stretches with time. As it sags, the sheet begins to droop. The drooping contour gives a more rounded shape to the eye opening instead of the almond shape of youth.

Eyelid lift (blepharoplasty), combined with brow lift and resurfacing procedures, can rejuvenate the area around your eyes. In part 2, we will discuss how we can make you look refreshed, younger and happier. Be sure to check out our other blogs and web pages for extensive plastic surgery information, including more information about eyelid lifts.