Eye Full

By: Mr Anil Pitalia
Created on 09th November 2009

Bothered by eye bags? Worried about the loose or baggy skin around your eyes? Specialist eye surgeon, Mr Pitalia of spaMedica, looks at the surgical and non-surgical options for rejuvenating the eyes and face

One of the challenges facing clients is knowing which practitioner to trust for their treatment. Important factors to consider in choosing a practitioner include: is that person a doctor with a surgical qualification such as FRCS (Fellow of the Royal College of Surgeons) and does the doctor also hold an NHS Consultant post; is the doctor a specialist in eyes, that is an Ophthalmologist, and does the specialist have any super-specialty experience in eyelids, that is Oculoplastic training. The anatomy of the eyes is intricate and an Ophthalmologist with Oculoplastic experience can offer the highest level of surgical skills when it comes to operating on the eyelids.

Droopy or puffy lids are a common complaint but the causes of these conditions can be varied. It's essential to understand exactly what is causing a patient's droopy, tired-looking eyes to ensure the correct type of surgical procedure is performed.

Brow lift
Brow ptosis or drooping is where skin and subcutaneuous tissue on and above the eyebrow sags. The effect this gives is of a low set brow that can make one look unhappy and angry. This is caused by ageing in general and can start as young as your forties and will affect many people by their fifties and sixties.  

Confusingly it can give the appearance of excess skin on the lid and I have seen patients who have incorrectly had blepharoplasty surgery without dealing with the cause of the problem. A drooping brow gives the appearance of excess skin on the upper lid and by correctly performing brow lifting surgery not only can the brow be restored to its natural position but the 'excess' upper lid skin is also automatically corrected.

Blepharoplasty
A surgical blepharoplasty is necessary if you genuinely have excess skin on either the upper or lower lid. As one ages, the skin of the lids becomes less elastic and can take on a stretched, baggy and hooded appearance, particularly so when there is also volume loss of tissues underneath the skin. In blepharoplasty surgery precisely the right amount of skin and muscle is excised to restore youthful lid contours and eliminate the wrinkled appearance around the eyes.

Orbital fat prolapse occurs when fat originally contained behind the eye moves forwards in to the eyelids, causing a bulging appearance. Dealing with this fat prolapse appropriately is essential as it can impact not only on the cosmetic outcome but also on the risk of visual loss.

Surgical blepharoplasty can be done under general or local anaesthetic. Like brow surgery, recovery is very rapid and an experienced surgeon will know how to minimise the scar and ensure it is well hidden.

Ptosis surgery
The levator muscle is the small delicate structure responsible for lifting the eyelid but as one ages that muscle can weaken and stretch. Out of all the three operations this is the most delicate as it requires microscopic dissection of the upper lid to reveal the thin levator muscle which must then be tightened and repositioned to restore the upper lid position to its normal and more youthful height.

This operation is better done under local anaesthetic as we sit the patient up during the procedure to determine the lid position before suturing the muscle in to place. Quite often this surgery is combined with a blepharoplasty to remove excess skin. Patients are kept comfortable and pain free at all times.

Non-surgical laser blepharoplasty
I only recommend this option to patients who don't need surgery - if their problems are on the milder end of the spectrum a laser blepharoplasty can delay or remove the need for surgery.

We can now achieve good skin tightening on the upper and lower lid with a carbon dioxide laser. The laser is delivered in a 'fractional' or 'fraxelated' fashion - that is the laser energy is delivered into the skin in a grid-like pattern thus leaving surrounding islands of untreated tissue which assist in the healing process and allow rapid recovery.

The laser's treatment protocols are tailored to individual patients. We can control how tightly packed or how far apart the laser dots are applied and the depth and power of the laser bursts. Practitioners using these types of lasers need to be careful to protect the eye itself when treating close to the margin of the lids.

The great thing about the laser treatment is that there are instant results - the patient can see the skin tightening and the wrinkles disappearing instantly and the results carry on improving for months as collagen regeneration takes place. The results are long lasting.

The holistic approach
Patients can sometimes focus on the changes to the eye area without considering the effect the ageing face has on their overall appearance. I believe it is important to take a holistic look at the face, as ageing is not usually attributed to one single problem area.

During consultation, I look at the skin laxity, skin complexion, open pores, pigmentation, the gravitational effects on the face, the volume loss in the face - and then determine the best treatment plan for an individual patient.

With the wide range of treatments and procedures on offer we can now deal with all these problems. A patient might need a surgical blepharoplasty but they also might need volume restoration which Sculptra or Sub-Q will provide. They also might have dynamic wrinkles requiring Botox treatment or have gravitational drooping in the jowls or cheek area which skin resurfacing would improve.

It might not be necessary to treat all the problems but we need to look at which are having a major impact on the face and tackle those.
CS&AM