We've all heard the saying "The eyes are the windows to our soul." The eyes really do reveal our thoughts and emotions, and convey information that words cannot. This is probably why we focus most of our attention on the eyes during personal interactions. Some of the earliest signs of facial aging occur in the area immediately surrounding the eyes. This is called the peri ocular area and includes the eyelids, lashes, eyebrows, cheekbones and temples. The skin in this area, especially the eyelids, is the thinnest on our bodies. It is also the most loosely attached. As a result, it is the first to show signs of aging.
The aging eye is made up of many different components. Although the most obvious visible changes are looseness of the skin and bags under the eyes, there are many less apparent changes that contribute to the overall aged appearance. These changes must be identified and addressed in order to achieve the best results. Probably the most overlooked sign of peri ocular aging is downward migration of the eyebrow. Brows that are too low can create a tired, unhappy or mean appearance. In addition, they can create the illusion of skin excess of the upper lids by compressing this area. The outer portions of the brow can also be pulled down by the long term effects of contraction of the muscle that encircles the eye, the orbicularis oculi.
The other important age related change is the loss of fatty tissue beneath the skin. Fat pads create that youthful fullness and a smooth contour between the lower lid and upper cheek. When the pad starts to descend due to age, a void is created between these two anatomically important structures, and the result is a sunken look. There is also loss of fat in the temples that can contribute to additional hollowness.
In my practice, the most commonly used surgical approaches to rejuventation of the peri ocular area are upper blepharoplasty (eyelid lift), lower blepharoplasty, forehead lift (brow lift), temple lift and fat transfer.