Solution to Tired Eyes Part 2

A Blog about the Fix for Tired Eyes by Dr. Loftus

We have found that one of the most common concerns women have is the appearance of tired, puffy eyes as they age. Now that you understand the anatomical changes that occur with aging around the eyes from Part I, we can discuss how to improve them. Plastic surgeons refer to an eyelid lift as a blepharoplasty. There are many different techniques, so we will focus on the basic concepts of correcting the anatomical changes about which you learned. Beware that tired eyes can also be due to droopy brows, and be sure to visit our Brow Blog to help sort this out.

The first concept we should emphasize is one of balance. Each area of the face changes with age. Because the areas are closely associated they influence each other. Thus, it is impossible to get a maximal result without rejuvenating the adjacent areas. Looking at it another way, if you only rejuvenate part of the face, the result may not appear as natural. Although you should understand this, you should not see it as a rule against having surgery to correct a single area that bothers you. Further, some people show signs of aging more early in one area versus another. So, it may be very reasonable to address only that area at surgery without compromising your result significantly.

Extra skin is generally removed through an incision in the upper and lower eyelid. Since the brow drops and pushes extra skin onto the upper eyelid, a brow lift should be considered for the best result. If the brow has dropped significantly and is not lifted, the stern appearance resulting from a low, flat brow will not likely improve. In some cases, it may worsen. As an alternative or in addition to skin excision, resurfacing with chemical peels or laser may be used to tighten the skin and improve the papery texture.
After the skin, we tackle the fat. The bulging fat around the eye is a source of controversy for plastic surgeons. Traditionally, blepharoplasty involved removing this "excess" fat to improve contour. Unfortunately, this can lead to an unfavorable appearance. Remember, volume is youth. If too much fat is removed the eyes appear more sunken and skeletonized. Although the fat no longer appears bulging, you can actually end up looking older or ill if fat is over-resected. Currently, plastic surgeons are removing less fat than in the past. We try to conserve every precious bit of volume possible. Frequently, the fat can be repositioned and preserved. Repositioning of the fat can be used to fill the tear trough deformity. That being said, it is sometimes necessary to remove small bits of fat to get a smooth contour.

Beyond removing extra skin and addressing fat, we want to improve shape. The rounded shape to the eye can be improved with a "canthopexy." The clothes line that we described suspending the lower lid attaches to the outer edge of the eye socket at a structure called the "lateral canthus." A canthopexy procedure tightens the clothes line and lifts the corner of the eye slightly. This restores the eye to a more youthful almond shape. We can perform upper and lower eyelid lifts together or separately to fit your specific needs.