Eyelid - Eyebrow Facial Rejuvenation

Eyelid - Eyebrow Facial Rejuvenation: Nothing has such a powerful impact on your development than your appearance - - not so much your actual appearance but a conviction that it is either attractive or unattractive. There is a startling bias towards aging in our society particularly towards those who are older and don’t look good. Many of my patients who are maturing recognize that looking their best is important. Those that look good, appear more creative and productive.

Since recorded time the eyebrow has played a roll in decoration of the face even in the ages where brows were left to wander as they choose, they still made some kind of fashion statement.

1. DEPRESSED EYEBROWS (EYEBROW PTOSIS).

Causes of flat low eyebrows:

1. Genetics
2. The resting tone of the forehead muscle group
3. Gravity
4. Overactive frown muscles of the inner part of the eyebrows (thinking, concentrating, squinting)
5. Overactive outer eyelid muscle with smiling - animation.

Treatment of eyebrow ptosis (dropped eyebrows):

A. Non Surgical

1. Cosmetics

• Pluck (“shaping”)
• Hair Lasers (templates)
• Bleaching
• Tattooing

2. Botox
Botox is one of the easiest treatments to perform poorly. Symmetry and harmony of the eyebrows are important to the face. Having Botox done in a comprehensive fashion is critical to your appearance.

3. ThermaCool
(RadioFrequency-RF) Synonyms: ThermaCool,Thermage, ThermaLift, Thermal Lifting, Therma Plasty, and Thermoplastic Contouring)

4. Combined Treatments

• Blepharoplasties
• Botox
• ThermaCool
• Cosmetics

B. Surgical

2. EYELID REJUVENATION
Blepharoplasties – crow’s feet laser resurfacing. The UltraPulse CO2 laser blepharoplasty and Sciton laser skin resurfacing has revolutionized cosmetic surgery for eyelids and the face. This exciting technology allows for excellent cosmetic results in upper eyelid blepharoplasty and transconjunctival lower eyelid blepharoplasty. Enhanced surgical visualization is permitted by a relatively bloodless field, resulting in a more precise and rapid surgical procedure.

The CO2 laser technique, using a special focusing handpiece, seals small blood vessels. This results in less post operative bleeding (bruising) and swelling.

Patient recovery is rapid and positive patient response is rewarding. At the same time as the blepharoplasties, if needed, laser resurfacing of the wrinkled lower eyelids and “crow’s feet” areas plus Botox results in increased patient satisfaction.

3. THE MANAGEMENT OF DARK LOWER EYELID CIRCLES
Skin discoloration, texture and tone changes of the lower eyelid area is a common cosmetic concern. In a cosmetic centre like ours we focus on all of the treatment options available for this unique annoying challenge.

Increased pigment (Hyperpigmentation)

• genetics
  • race
  • post-inflammatory
    • atopic dermatitis
    • post injury – irritation
• Atopic patient – extra skin folds (Dennie’s line)
• Vessel network pattern
  • periorbital reticular blue veins
  • telangiectatic arborizing and linear vessels (venous pattern)
• Baggy lower eyelids
  • herniated fat pads - causing reflected light
  • with or without wrinkly skin of the crow’s feet and eyelids
• Wrinkles
  • crow’s feet – when smiling
  • crow’s feet extending to the lower eyelid (present with animation and relaxed)
  • genetics
  • aging
  • smoking (including 2nd hand smoke)
  • accumulated sun exposure over a life time
• Festoons – lower eyelids (see note on Festoons)

Treatment options for dark circles under the eyes:
Kinerase (cream, lotion) used daily over a period of months. (improved texture, tone, and fine lines in the periorbital area).

1. Chemical peels – difficult to blend and feather in actinic damaged faces.
2. Q-Switched pigment lasers, Q-Switched 532 nm, Q-Switched Alex 755 nm and Q-Switched YAG 1064 nm, Q-Switched Ruby 694 nm.
3. Resurfacing. The Sciton laser for moderate wrinkles.
4. Vascular lasers including the long pulsed 1064 YAG combined with the Vasculight VL head and the VersaPulse 532 system.
5. The orbital and cubital festoons can be treated with radiofrequency – ThermaLift (Thermage).

4. LOWER EYELID FESTOONS
Features: Festoons are loose muscle and skin that drape from the lower eyelids and can be a major cause of baggy lower eyelids and the upper cheek zone. This baggy tired looking skin hangs just above the cheek bones.

Causes of Festoons:

1. Genetic’s
2. Accumulated sun damage – sun exposure primarily in photo skin types I, II, and III.
3. Lifetime of smoking (including 2^nd hand smoke)
4. Natural aging process

Treatment of the lower eyelid festoons:

The festoons of the lower eyelid are often associated with baggy lower eyelids caused by herniation of the three fat pads plus extra wrinkled skin.  These festoons can be improved with a combination of the lower eyelid laser blepharoplasty and resurfacing of the lower eyelids with the Sciton resurfacing.

Other treatment options include:

• Surgical – muscle plication with the lower eyelid blepharoplasty
• ThermaLift – ThermaCool (Thermage company) – an option for some patients

Complications of surgical treatments:

• Technique dependent
• Uneven – asymmetry of scar tissue with subepidermal fibrosis
• Visible scars
• Hypertrophic and keloid scars
• Vascular scars that may take many years to fade

5. REMOVAL OF PERMANENT EYEBROW AND EYELINER MAKEUP – (TATTOOING)
During the past few years permanent eyeliner and eyebrow makeup has increased dramatically, creating a reservoir of patients who are unhappy with the end results. The pigment instability, the chemical composition, the color variations, pigment migration, artistic technical errors, and style changes lead to the unsatisfied patients requesting removal of the tattooing. Removal of permanent eyebrow and eyeliner tattooing presents a challenge. Past surgical techniques, the Argon laser and CO2 lasers may create undesirable scarring.

The use of the newer Q-Switched lasers have improved the results. These lasers specifically destroy the pigment and save the skin intact without creating scarring. We have three Q-Switched tattoo removing lasers (Q-Switched (Nd):YAG 532, the Q-Switched (Nd):YAG 1064, and the Q-Switched Alexandrite 755 nm.)

The eyes are protected by special laser contacts which our team easily inserts and remove. Treatments are done at 4 to 6 week intervals for 2 to 6 treatments depending on the clinical response.