Lower Eyelid Options

We hear it all the time: the eyes are the windows to the soul. Whether or not this is true is up for debate, but we know for certain that the eyes are one of the first areas of the face to show signs of aging. The skin in this area is extremely delicate, and time, sun, and lifestyle choices such as drinking and smoking can all take their toll, causing fine lines, wrinkles and puffiness. Since the eyes are also one of our most recognizable features, when they look tired and haggard, it adversely affects not only how we look, but how feel about ourselves. Dr. Richard Restifo of Orange, CT and Dr. Kevin Smith of Charlotte, NC discuss aging in the lower eyelid/tear trough area, and the many options for restoring a more youthful appearance.

by Katherine Stuart
and Kevin Smith, MD and Richard Restifo, MD

The Tear Trough is the New Hot Spot

Everyone today seems to be talking about the “tear trough” area, which is the hollow beneath the lower lid. Problems in that area can range from dark circles to under-eye “bags” to crinkly skin. Finding the right solution is really going to depend on the patient, says Dr. Restifo, and, “what the patient’s anatomy is and what the patient’s goals are.” It’s the surgeon’s job to treat each patient as an individual.

Some will definitely do best with a lower blepharoplasty,  a surgical procedure to remove excess skin and/or fat and tighten the muscles in the lower lid. Others may be best served by injectables. For example, filling in the tear trough area with an injectable filler is the ideal method for treating dark circles, but under eye bags are best eradicated with surgery. However, since injectables are both reversible and go away with time, they’re low risk and as such, a great first step. Patients can try fillers in the under-eye area and if they aren’t happy with the results then they can decide whether or not to go to the next step, surgery.

Tear Trough is Juncture between the Lower Lid and Cheek

Dr. Smith is happy to see the tear trough, “finally getting the attention that it deserves.” One of the reasons that the tear trough area is so important in terms of how it affects the overall look of the face is that it’s the juncture or transition between the eyelid and the cheek. Two things can happen to make it look aged. One, a patient can develop fat pads either due to genetics or lifestyle choices that make the lower eyelids puffy and which cause a shadow in the valley beneath the mountain of puffiness. The second is that a patient can lose cheek volume, which creates a valley in the tear trough area. Filling up this hollow or valley makes the juncture more smooth, restoring a more youthful, rested look.

Patients who have puffy lower eyelids, week muscles and wrinkly skin are going to probably best be served by a lower blepharoplasty, although, “we can mask that need for a blepharoplasty with a filler,” says Smith. Like Dr. Restifo, he loves the fact that with fillers a, “patient can kind of test the waters”. However you decide to get rid of the issue in the tear trough area, it will make you look not only more youthful, but more healthy.

Patients do have to be careful not to go overboard with the fillers. As Restifo explains, there is definitely, “a subset of patients that for whatever reason will never have surgery”. They’ll simply continue with fillers beyond the point where they look good. “Adding volume is not the answer to skin laxity,” says Smith. And when you try to use fillers to plump up skin that has lost its elasticity, you get that “filler face” often seen on the red carpet.