Drooping eyelids and eyebrows.

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This is a great question.  We all have different patterns of facial aging depending on our parents, families, and ethnicities.  So at the end of the day, you’ll need a consult or two with good dermatologists or plastic surgeons in your area.

Treatments for this area have evolved since that last post, so here are some updates.

Understanding how the loss of volume in the temple contributes to the appearance of the eyebrow tail and eye area.

If you don’t believe me on this, take your fingers on each side in that hollowing temple area and give a little pinch. Very little lift there makes a big difference.  Also, put one finger above the tail of the eyebrow and move the skin up 1/4 inch or about 1/2 cm.  It makes a big difference doesn’t it?   Just replacing the lost volume in the temple helps to support this whole area and make it look better.

Which fillers are good in the temples?

How is this done?  Well….experts differ on this.  I/our office prefers Sculptra because is works and usually takes 2-3 treatments for the base.  It has the best safety profile in the temple, and once the base is set it’s low maintenance. Usually one treatment once a year.  The problem?   It may be hard to find expert injectors experienced enough to do this in your area.

What are the problems with HA fillers?

  • For HA  fillers (hyaluronic acid fillers like Juvederm, Restylane, etc.), it’s much easier to find injectors, but safety is an issue.  A careless injector can block an artery and cause blindness.  Worldwide there are more than 200 cases of blindness caused by fillers, most of them in Asia, but some in North America and Europe.
  • There is a proliferation of nurse injectors in the U.S., many of whom don’t have much training. And some doctors are doing this who don’t have much training.  Look for an experienced office, with a least a 10 year history of solid work in aesthetic dermatology.  Using at least a 22-25 gauge cannula (not 27 or higher) improves safely. And not more than 1 syringe at a treatment session if it’s being used solely for the temples.

Combining non surgical treatments

Some of the nonsurgical eye area treatments can be safely combined on the same day for more results.  Again, experts only please!  For example, an eyelid Thermage treatment (FDA approved eyelid tip) can be done first for tightening.  Then cooling for 15-20 minutes, and immediately after a CO2 laser eyelid treatment.   A Sculptra treatment can be done in the temple area. And after that a Thermage eyelid tip treatment on the actual eyelids.

Safety is key.  Whenever someone is working on your actual eyelids an intraocular shield must be used.  These look like a special contact lense. The eye itself is numbed with drops (like a glaucoma check), a cushioning gel put on the lens shield and then the shield put in.  It doesn’t hurt, and protects your eye in case you suddenly open them at the wrong moment.  Be sure to talk to your doctor in advance if you have any cornea problems.

Surgical eyelid treatments

  • Upper lid hooding (blepharoplasty) still has a high patient satisfaction rate with a good surgeon.
  • Lower lids – the satisfaction rate is lower because it’s much tricker for surgeons to adjust the skin and the fat pads under the eyes.
  • Eyebrow lifts – still not great satisfaction due to problems with the scars up the hair bearing areas, problems with symmetry of the eyebrows, and too much lift creating a chronically surprised look.

Hope this helps ,

Dr. B

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