I had a midface lift at the time of my eyelid surgery, and now my eyes look different. Will canthal surgery correct my problem?
The most critical issue here is to understand how your face has changed.
You are absolutely correct to say that your eyes have changed. However, your analysis of the problem is not correct. I suspect that very few surgeons you consult will understand the issues. At the same time I am equally certain that many surgeons would be more than happy to perform a lateral canthoplasty for you. They will mean well but they are simply going to make your situation worse, not better.
I completely agree that surgery has altered the shape of the eyes. This is the most obvious change. The outer corners of the eyes are higher after surgery compared to your preoperative status. There is also a subtle lower eyelid contour abnormality of the lower eyelids. It is true that a properly executed lateral canthoplasty has the potential to reposition the lateral canthal angle. In my many years of repairing prior eyelid surgery, I have found that very few surgeons are capable of actually achieving that type of result in a natural way. Not impossible, just very difficult as the surgery must be done with the patient at least awake enough to open and close the eyes to judge the effect of repositioning of the angle. If surgery is performed under general anesthesia, then in my opinion, the likelihood of success is very low.
Canthoplasty, and to a lessor degree, cathopexy, risk over shortening the lower eyelid. It is true that many surgeons will shorten the lower eyelid as part of the canthoplasty procedure. The procedure is taught this way and this maneuver is important for pathologically lax eyelids. However, over shortening an eyelid that does not need to be shortened will simply force the lower eyelid below the curvature of the eye. This will actually make the lower eyelid look more pulled down. The outcome will be disappointing.
So lets talk about the real issue. It is interesting how important the eyes are in interpersonal interaction. Subconsciously, we scan the face of the person we are speaking to. During conversation, we actually scan a triangle on the face that includes the eyes, the nose and to a lesser degree, the mouth. This is so profoundly ingrained, that one expects someone listening to you to look at you in this manner. We are not even be aware of this gaze pattern. However, we can be acutely aware when the pattern is altered in someway. What you would experience when you are speaking to someone is the sense that they are not really paying attention to you. When does this happen? Studies have shown that changes in the face will alter this scan pattern. There are some very nice studies of this in the head and neck literature in looking at scan patterns when viewing someone who has a facial lesion or just had surgery to remove a facial lesion.
How does this apply to this situation? If you look carefully at your after photograph, you face demonstrates a classic facial defect caused by your mask lift. The forehead dissection has resulted in atrophy of the fat pads that extend from the temple to the orbital rim. This hourglass hollowing of the temple areas I call the plateau midface deformity. Essentially the loss of the fat volume skeletonizes the zygomatic arch. This little bit of facial fat plays a critical role. This cushion of fat at the side of the face serves to separate the eye aesthetic area from the temple aesthetic area. This slight cushion of volume helps maintain gaze on the eyes. Without this fat volume, the scanning gaze is falls off the eyes and is drawn into the temple area. You are left with the feeling that people are not paying attention to you. Since the primary reason many women (and men) have cosmetic surgery is to stay relevant, this feeling of being ignored can precipitate a narcissistic crisis. The fact that your surgeon cannot understand your concerns (and I promise you they really don’t get it) is even more infuriating. Because like you, they don’t see what the issue is, you get treated like a problematic, ungrateful, impossible to satisfy (insert your own description here) person. Naturally this can precipitate a break down in the doctor patient relationship.
In the example shown here, surgery was used to correct the problem. Previously placed cheek implants were removed and replaced with a hand carved ePTFE orbital rim implant. The lower eyelid was also lengthened using hard palate graft. Because it is necessary to sew the eyelid closed for a week to allow healing means that only one eye can be done at a time. For some individuals who only have the plateau midface, fillers can be used as an alternative to facial surgery.
First, there is no substitute for an actual personal consultation. Generally for this type of problem the best solution for many is adding hyaluronic acid filler to the area where you have lost volume. These products last quite a while and this can be a workable alternative to corrective surgery. For some, surgery is necessary. The most important thing is to avoid having a fix by doctors who do not understand what the issues are. Unfortuately, if you don’t see it, you can’t fix it.
Kenneth D. Steinsapir, MD
About Dr. Steinsapir
Dr. Steinsapir is a much sought after oculofacial surgeon. He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, fillers and cutting edge reconstructive eyelid and midface surgery. He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions. He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago. He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage. He is widely published and lectures to other surgeons nationally and internationally. He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA. His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities. Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.
To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Droopy Eyes after a Midface Lift
Complications following a midface lift are especially disconcerting because they can affect the basic functions of your eyes. Whether your eyes begin to droop, tear, or fail to blink, any change in the way your eyes and face function is reason enough to contact your doctor. But sometimes, surgeons panic in these situations and respond with a fix-it mentality and may be encouraging you to undergo corrective surgery immediately. Your surgeon may just want to take care of the problem as quickly as possible and as a result, you may be receiving mixed messages from your physician about the best course of action. However, immediately following your facelift may not actually be the right time to fix the problem.
Undergo a consultation
Before taking any action to correct your midface lift complications, carefully weigh your confidence in your current surgeon. There is no substitute for an in-depth personal consultation because discussing your problem with your doctor over the phone doesn’t allow him or her to see and fully understand the physical issues. Occasionally, the description of what is going on and the actual physical complications are not the same.
If you are not 100 percent confident in your surgeon and are casting about for opinions from strangers, listen to your feelings. Do not blindly follow the recommendations your original surgeon or any surgeon if their recommendations do not make sense to you. While you may not like your appearance and may be experiencing profound disappointment, these issues are seldom a medical emergency. Don’t commit to a second surgery unless you have a clear understanding of the following:
- what is going on and why these complications are occurring,
- what type of surgery your doctor has planned,
- why a surgical solution is necessary at this time,
- the risks of a second surgery, and
- the probability of success or failure.
The risks of midface and lower eyelid surgery and corrective surgery
Lower eyelid surgery and midface surgery have significant risks associated with them. Your surgeon may not fully understand these risks. If you’re experiencing complications it does not mean that your surgeon did anything below the standard of care. However, how your surgeon addresses the problem can make a profound difference and he or she should not rush the process.
The anatomy described in some of the most important and most recent papers in the field of lower eyelid and midface surgery done through a skin incision under the lower eyelashes (infracillary incision) is inaccurate. Dr. Steinsapir recently reviewed the literature on this subject and presented it before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium. Some of the core papers describe anatomic hypotheses rather than proven anatomic fact. For example, the soft tissue of the cheek is mobile (i.e. it slides when we smile), and the lower cheek is also mobile over the lower half of the face. In this location, the nerves responsible for facial expressions around the mouth travel in such a way that it is possible to safely dissect this plane in the lateral half of the lower face; this is a key aspect to the so-called deep plane facelift.
Similarly, surgeons dissect under the skin and lower eyelid muscle to perform midface lifts. Published papers appear to support the hypothesis that this midface lift technique can be performed without injuring the nerves that feed the eyelids. Unfortunately, a hypothesis is a scientific guess, it does not make an established anatomic fact. There is also clear evidence in published papers suggesting that the nerves that supply the lower eyelid orbicularis oculi muscle travel in this so-called glide plane, which is actually just somewhat mobile fat and loose connective tissue between the cheek bone and the orbicularis oculi muscle.
So why do doctor’s still perform this kind of surgery despite the risks? Despite the inaccurate papers, it is possible to dissect in this plane without significantly altering the nerve supply to the orbicularis oculi muscle in some individuals. Yet others may not do well. This may have to do with how aggressive the surgeon is and the exact nature of the distribution of these motor nerves, which do vary somewhat from person to person. Additionally, when this dissection is carried out laterally into the crowsfeet area, it is also possible to do significant damage to the nerves that provide innervation to the orbicularis oculi muscle in the upper eyelid as well. This is significant because the elements of the orbicularis oculi muscle near the lower eyelid margin are responsible for blinking the eye closed. Without this critical blink function, tears are not moved across the corneal surface properly resulting in dry eye and tearing issues. When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.
The remedy for midface and lower eyelid surgery complications
To address eyelid complications from a midface lift or lower lid surgery, the best answer is to avoid further eyelid tightening and allow the tissues to heal. In six months or more come back and address the situation with your surgeon if problems persist. By preserving as much of the lower eyelid and not cutting out tissue―as would be the case if your doctor were to try to fix the problems immediately following your initial surgery using a technique called canthoplasty―there are many more options and increased likelihood of an improved outcome if you allow the tissue to heal. While in the healing process, keep lines of communication open with your surgeon or look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cosmetic eyelid surgery. Be skeptical of solutions that must be done “urgently” or don’t make sense. While very few of these complications mend themselves, with time it may improve so that less work may be needed than first thought.
About Dr. Steinsapir
Dr. Steinsapir trained alongside the inventor of BOTOX and has performed thousands of BOTOX treatments in Los Angeles since 1988 and recently patented his Microdroplet BOTOX technique. He is a board certified eye surgeon and fellowship trained in oculoplastic surgery and cosmetic surgery in Southern California where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Stem Cell Facelift vs. Fat Transfers
It is said that every good lie contains a grain of truth. The truth about so-called Stem Cell Facelifts is that fat harvested from your body does contain small numbers of adult stem cells. Taking that fat and transferring it to your face as a fat transfer does place these adult stem cells into the face. However, the promise of the name: Stem Cell Facelift is a lie. The implication is that these stem cells in some way rejuvenate the face. Like fad dieting and get rich quick schemes, the public can’t get enough of this type of hype. You would think at some point people would have learned that if it sounds too good to be true it probably is. You would be wrong. Enterprising cosmetic surgeons have learned this lesson as well. So we are bombarded with new procedures with enticing names that seem so scientific. It would be great if the Stem Cell Facelift was based on science rather than science fiction. Do so-called Stem Cell Facelifts provide facial rejuvenation? Yes, but not because of the adult stem cells in the fat. This is just a new way for cosmetic surgeons to insult your intelligence.
The Real Benefits of fat grafting
The reality is, there is no evidence to suggest that stem cells present in adult fat placed in the face have any impact or role in the effects of volumizing the face with grafted fat. Fat grafting procedures work because about 60 to 70 percent of the transferred fat survives, creating long-lasting volume and this helps improve the appearance of the face because loss of volume over time is an important factor in making one look older as we age.
Fat grafting is a biologically safe procedure because the fat transferred is from your body. It is precisely delivered through a tiny poke in the skin that heals without scarring and the procedure can be done under local anesthesia. The fat transfer in a “stem cell facelift” may be combined with other procedures like a traditional facelift or midface lift. It is more accurate to refer to a “stem cell facelift” as “facial volumizing with grafted fat.”
Fact and fiction
It is true that the stem cells in your body fat can be separated from the fat and, in a test tube at a research lab, be stimulated to develop into other cell types. There is a lot of impressive research being done in this area so we can learn more about important potential medical uses of stem cells. But there is no evidence to support the idea that the stem cells in the grafted fat are stimulated this way when transplanted from one part of your body to another
Finding a doctor who relies on science
The biggest concern with the “stem cell facelift” is not that it’s a bad or unsafe procedure, but rather that the term “stem cell” is a deceptive name that promises something that it does not deliver. When seeking treatment, make sure that your potential cosmetic surgeon relies on science, experience, and skill rather than catchy marketing phrases. Your doctor should be a specialist in facial cosmetic procedures and completely honest about what a treatment does and does not do. Relying on the honest application of skills, proven methods, and experience will help you achieve your goals. Deceptive marketing practices violate the principles that make a good working relationship between the surgeon and the patients, which must be based on well-placed trust and honesty.
About Dr. Steinsapir
Dr. Steinsapir is an expert cosmetic plastic surgeon who has skillfully handled face lift and fat grafting procedures in Los Angeles and Beverly Hills for over 20 years. He is a board certified ophthalmologist surgeon and fellowship trained in oculofacial surgery and cosmetic surgery in Southern California where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert cosmetic surgery provider.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Complications after surgery
Complications following a midface lift and eyelid surgery are especially disconcerting because they can affect the basic functions of your eyes. Whether your eyes begin to droop, tear, or fail to blink, any change in the way your eyes and face function is reason to be concerned. But sometimes, inexperienced surgeons panic in these situations (even long-in-practice, but inexperienced surgeons) and respond with a shoot-from-the-hip, fix-it mentality, and may push you to undergo corrective surgery immediately. Your surgeon may just want to take care of the problem as quickly as possible and as a result, you may feel pressured to have a corrective surgery. There are certainly times where immediate work is appropriate. Before you agree to such a fix, ask yourself if you are still comfortable trusting your surgeon. In his book Blink, Malcom Gladwell describes the process of “thin slicing;” the way our intuition rapidly assesses a situation. That intuition is ignored at our peril. If the hair on the back of your neck is standing up because your surgeon wants to hustle you back to surgery, ask yourself: are you comfortable with what is being proposed? If you are not comfortable, your best course of action is the natural one―dig in your heals. There are occasional situations that are medical emergencies. However, these are truly rare. There is almost always time for a second opinion.
Undergo a consultation
Before taking any action to correct your complications, carefully weigh your confidence in your current surgeon. There is no substitute for an in-depth personal consultation because discussing your problem with your doctor over the phone doesn’t allow him or her to see, and fully understand the physical complications. Occasionally, the description of what is going on and the actual physical complications are not the same. Fixing complications is specialized business. Even if your surgeon does a lot of primary cosmetic surgery, he or she may be relatively unsophisticated when it comes to repairing surgical complications, especially when this work affects the function of the eyelids.
If you are not 100 percent confident in your surgeon and are casting about for opinions from strangers, listen to your feelings. Do not blindly follow the recommendations your original surgeon or any surgeon whose recommendations do not make sense to you. Don’t commit to a second surgery unless you have a clear understanding of the following:
- What is going on and why these complications are occurring,
- What type of surgery your doctor has planned,
- Why a surgical solution is necessary,
- The risks of a second surgery, and
- The probability of success or failure.
The risks of midface and lower eyelid surgery and corrective surgery
Lower eyelid surgery and midface surgery have significant risks associated with them. Your surgeon may not fully understand these risks. If you’re experiencing complications it does not mean that your surgeon did something that another surgeon might have done in a similar circumstance. However, how your surgeon addresses the problem can make a profound difference and he or she should not rush the process.
The anatomy described in some of the most important and most recent papers in the field of lower eyelid and midface surgery done through a skin incision under the lower eyelashes (infracillary incision) is inaccurate. Dr. Steinsapir recently reviewed the literature on this subject and presented it before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium. Some of the core papers describe anatomic hypotheses rather than proven anatomic fact. Unfortunately, a hypothesis is a scientific guess―it does not make an established anatomic fact. Lower eyelid surgery through the lower eyelid skin is one example of this. Surgery damages the motor nerves that help support the lower eyelid margin leading to complications that can surprise the unsuspecting surgeon. Naturally, they are not going to say that they are surprised but be assured they would not perform surgery this way if they thought it would cause a problem.
So why do doctors still perform this kind of surgery despite the risks? Despite the inaccurate papers it is possible to dissect in this plane in some cases without significantly altering the nerve supply to the orbicularis oculi muscle. Motor nerve damage to the orbicularis oculi muscle near the upper and lower eyelid margin affects the blink and weakens eye closed. Without this critical blink function, tears do not move across the corneal surface properly resulting in dry eye and tearing issues. When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.
The remedy for midface and lower eyelid surgery complications
To address eyelid complications from a midface lift or lower lid surgery, the best answer is to avoid further eyelid tightening and allow the tissues to heal. By preserving as much of the lower eyelid function and not cutting out additional tissue―as would be the case if your doctor were to try to fix the problems immediately following your initial surgery using a technique called canthoplasty―there are many more options and increased likelihood of an improved outcome if you allow the tissue to heal. While in the healing process, keep lines of communication open with your surgeon or look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cometic eyelid surgery. Be skeptical of solutions that must be done “urgently” or don’t make sense. While very few of these complications mend themselves, with time it may improve so less work than originally thought may be necessary.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Can I exercise my facial muscle for an improved tone?
Exercise and diet are essential for a healthy lifestyle, but it’s important to recognize their limitations. Not every condition can be cured by exercise, vitamin supplements or fad diets, especially when the problem is not a result of poor nutrition or inactivity. We absolutely encourage you to exercise moderately and eat well, but we admit to being skeptical of the arising claim that exercising facial muscles can restore youth and beauty to one’s face. This is an unproven method, and when one considers that they are likely still using their facial muscles just as much as they were ten years ago, it becomes apparent that their aging looks are unlikely due to facial inactivity.
It’s appealing to believe that we can resolve all of our concerns through exercise, and while research shows that exercise does benefit our health in many ways, it also shows that further medical treatment is required for many conditions. Just as someone with presbyopia cannot exercise to regain the ability to focus for reading vision, it’s not likely that you’ll be able to reverse the effects of age, time, gravity, and stress by wiggling your face or by having electrical currents stimulate your facial muscle to contract.
There are many types of facial cosmetic surgery and other treatment that can help you obtain the result you need if your doctor determines that you are a suitable candidate. These range from minimally invasive treatments with little-to-no downtime like BOTOX and undereye Restylane to surgeries like the facelift and plastic eyelid surgery including eyelid reconstruction, which give dramatic yet natural results to individuals with far-reaching concerns. While it is impossible to know which treatment, if any, is most suitable for you before a private consultation with the best facial cosmetic surgeon for you, you can be confident that there are a wide range of treatments that an expert can custom-tailor to meet your needs.
As a specialist in facial cosmetic treatments, Dr. Steinsapir has treated many individuals who first explored a variety of “natural solutions” for their aesthetic facial concerns. Frustrated when they saw no results, they eventually consulted with Dr. Steinsapir and opted for proven treatment methods that provide dramatic yet natural results. This human tendency to pursue unproven treatments is not a fault; it is normal to want to independently resolve a problem using the least invasive and most economical method possible.
Dr. Steinsapir is focused on your personal goals and comfort level. Dr. Steinsapir always asks you questions about your specific goals, individual situation, and preferences so that he can plan a solution that is aligned what you want, so you can feel comfortable knowing that you are ultimately in control of your treatment plan. Dr. Steinsapir very much believes in using the least invasive method for accomplishing a particular goal; for example, he does not recommend a forehead lift when a BOTOX treatment for wrinkles will will meet your goals – and he is a leader in his field of minimally invasive solutions.
If you are seeking a proven treatment with an experienced facial plastic surgeon with extensive training in oculofacial plastic surgery, we invite you to a personal consultation with Dr. Steinsapir today. Dr. Steinsapir is honest, friendly, and can talk to you about customized treatments that give you the results you seek by addressing your specific needs and unique facial features. Please call us today to schedule a time when you can speak with Dr. Steinsapir.
About Dr. Steinsapir
Dr. Steinsapir is a board certified cosmetic surgeon and oculoplastic surgeon in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves patients at UCLA, where he is an assistant
clinical professor. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of facial cosmetic surgery and eyelid reconstruction, which can be a vital part of your evidence-based treatment plan.
What are the best lasers to improve my dark circles?
People love to talk about lasers and technology, and while lasers are very valuable in many medical procedures, they have a limited place in cosmetic procedures. Lasers have been touted as a great way to improve skin texture, scars, and even problems like dark circles under the eyes which are actually caused by the skin optics of the lower eyelid. In actuality, lasers once seemed like a promising technology that failed to deliver on so many promises when it comes to cosmetic treatment.
Under Eye Restylane Before and After Photo
There are many potentially disfiguring side effects with laser skin treatments. For example, CO2 laser resurfacing can cause textural abnormalities and injure the skin’s melanocytes, which causes unsightly hypopigmentation. Still other methods like fractional laser treatments have such a mild effect that you may or may not even notice a difference. Furthermore, since laser equipment is so expensive, you end up bearing the high cost as the consumer even when a less expensive treatment may be more effective. We do not mean to completely devalue lasers; it is of course reasonable and fair that the treatment recipient bears the cost of the medical equipment and procedure, and there are in fact some delicate and truly impressive surgeries that are best done with a laser. However, when it comes to cosmetic procedures and facial skin treatments, lasers are often not the best choice.
What is the best treatment to improve my dark circles?
Let’s rephrase the original question and consider how to find a more appropriate treatment solution. Some better questions to ask are, what is causing my dark circles, and what is the best cosmetic treatment to improve them? This way you allow your physician to diagnose you and help you develop the best treatment plan for your needs, rather than assuming that you already know what will work. Just as it is a common misconception that lasers are the best method for treating facial skin problems, it is also a misconception that the dark circles or under eye hollows are a problem with skin pigmentation.
In most cases, the dark circles under the eyes that we observe are actually caused by a tissue deficiency. There is too little subcutaneous (meaning “under the skin”) fat in the under-eye region, which is frequently caused by a descent of the malar fat pad, or soft cheek tissue, over time. This deficiency creates an optical problem because light hitting the skin is absorbed by the dark red muscle beneath it, rather than a youthful layer of fat. The tear trough skin here may be too thin also, compounding the problem, but this is not a skin problem you’ll want to “correct” with lasers. The skin here is very delicate and fragile, and artificially changing its texture through lasers and scarring will not make for a good look. The key is to address the underlying problem by correcting the subcutaneous deficiency.
The most effective treatments for improving under eye circles depend on the individual, but usually the safe, reliable, and recommended solutions that work best are either a midface lift or undereye Restylane. The midface lift addresses severe structural concerns and returns sagging tissue to its natural, youthful position, successfully treating the under eye bags and restoring balance to the face. Restylane under the eyes is a facial filler that corrects the tissue deficiency, and it’s a great option for those with a less pronounced problem or who may not be ready for surgery for personal reasons. The Restylane filler allows the skin associated with the dark circle to drape differently and this greatly improves how light interacts with the lower eyelid lessening the appearance of the dark circle.
How can Dr. Steinsapir help?
Dark under eye circles are one of the most common concerns that Dr. Steinsapir treats. His practice is one of just a few in the world that makes the treatment of under eye hollows a major focus of specialization. Dr. Steinsapir pioneered the midface lift with a hand-carved orbital rim implant, and he also invented the patent-pending treatment method Deepfill Restylane, both of which are impressive and respected solutions for correcting under eye deficiencies. As a leading expert in cosmetic procedures to address the undereye hollow. He is a noted lecturer and writer on this subject. He believes in developing an individualized treatment plan for each individual based on minimally invasive methods with safe and proven results. Please contact us today to find out how Dr. Steinsapir can correct underlying problems and help you restore your vibrant, youthful appearance.
Can surgery improve my dark circles?
There are a variety of means to address dark circles under the eyes, and surgery is often the best recommendation. Dr. Steinsapir is one of just a few physicians who make treatment of under eye hollows a major focus their practice. The best course of action always depends on a personal consultation and individualized treatment plan. Let us discuss a few possibilities here.
Dark Circle Surgery Before and After
Filler or Surgery?
In many cases, especially when the presence of dark circles under the eyes is pronounced, surgery may be advisable as the most beneficial option. However, Dr. Steinsapir understands that there are many people who need surgery but are too apprehensive to seek it – perhaps they had a negative prior experience and are emotionally traumatized, or they may not be prepared for surgery for other personal or financial reasons. In these cases, Dr. Steinsapir recognizes the importance of respecting emotional limits, and in order to help those who postpone treatment because they desire to avoid surgery, he developed the Deepfill Restylane method of correcting under-eye deficiencies.
Both fillers for under eyes and surgeries, such as the midface lift and arcus marginalis release, have been demonstrated to be safe and highly effective in treating under eye problems. Find a surgeon who specializes in the treatment of dark circles under eyes to see what he or she recommends. Your doctor should help you decide the best approach that is right for you. When you make your decision, remember that surgery is longer-lasting and may yield more powerful results, while under eye Restylane is a flexible, long-lasting but not permanent, and necessitates little-to-no recovery time, making it a great option for those whose personal or work situation may limit their ability to undergo surgery, as well as those who have a less pronounced need for dramatic treatment.
Whether you and your midface surgeon ultimately decide to opt for surgery, a filler, or no treatment, the key to a successful outcome will be planning an individual treatment and then performing it with skill and precision so that enough treatment is given without overdoing it, and so that the look is natural and suits your face.
How Surgery Helps
Surgery addresses lower eyelid contours that contribute to the dark circle. The effect is a less haggard appearance. While no surgery lasts forever, the effects of surgery last longer than the non-surgical treatments.
Find a facial cosmetic surgeon who specializes in midface and particularly under eye treatments who also has the training, experience, and great results to make him or her highly qualified. This is important because your surgeon will need to customize your surgery. When working in the midface areas, an assembly-line-style treatment approach is not a good idea. The key to a great outcome is careful planning and performance of the surgery to make it suit you on an individual basis.
One problem with the midface area that is frequently overlooked is the descent of the malar fat pad. This worsens the hollow under the eye, the midcheek groove, and even the nasolabial fold. You may interpret what you see as a simple hollowing around the eyes, but often this is truly an entire midface concern. A midface lift can address all of these areas to smooth out your features and restore the fullness associated with youth. Dr. Steinsapir helped pioneer the hand-carved ePTFE orbital rim implants in the midface lift, which greatly improves the area around the eyes.
There are different kinds of midface lifts, and the vertical midface lift can be a great way to lift the soft tissue in the cheek back into the lower eyelid where it belongs.
Another option may be the arcus marginalis release, which is suitable for people who have too much lower eyelid fat while also experiencing an under eye deficiency that creates a hollow. To address this, your surgeon may make a small incision behind the lower eyelid so that the scar is hidden, and then he or she surgically rotates the lower eyelid fat to place it over the orbital rim, filling the hollow naturally and relieving your eyelid of excess tissue. This is a comfortable surgery that should usually be performed under local anesthesia, followed by ten to twelve days of recovery time.
Finding the Best Cosmetic Surgeon
Dr. Steinsapir has had multiple fellowship trainings in both cosmetic surgery and eyelid plastic surgery, making him especially knowledgeable about how general facial treatments interact with specialized eye area treatments. As a specialized eyelid plastic surgeon, he is qualified to customize your treatment in this sensitive under eye area in ways that a generalist may not be able to. Dr. Steinsapir is attuned to your need to carefully decide whether a surgery or a filler is better for you, and he can help you make an informed decision. Contact us today to find out how a private consultation can help you plan a course of action that improves your physical appearance and meets your needs.
