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Do Your Eyes Make You Look Tired?

By Dr. Jonathan Hoenig

The Problem : A Tug of War

Throughout one’s lifetime, the four muscles that contribute to eyelid closure tighten and relax millions of times due to actions as slight as blinking to as strong as squinting in the sun. These four muscles are opposed by only one muscle that raises the eyebrows. In time, this constant “tug of war” between the opposing forces that pull the eyebrows up and down leads to drooping of the brows and wrinkles across the forehead.

The first damaging effects of this “tug of war” become apparent as early as the 3rd decade of life, and gradually worsen over time. As the eyebrows droop, the skin between the eyelashes and the eyebrow that was once stretched smoothly across the eye begins to overlap. For women, this is first noticed as difficulty in applying eyeshadow because the “platform” on the upper lid begins to disappear beneath overhanging skin.

Doctor, Cut It Out!

This phenomenon of the skin folding over the eyelid crease (known as hooding) gives the appearance of having too much fullness of the upper eyelids. Countless patients have expressed concern with this apparent excess of eyelid skin. Classically, they pinch their upper eyelid and say “Doctor, my eyelids make me look tired. I want you to cut this skin out.” In reality, few patients would benefit by having the skin excised (cut out) since many do not truly have excess skin. On careful examination when the eyebrows are raised to their more youthful position, there is actually little to no extra skin on the eyelid. In fact, removal of upper eyelid skin may pull the eyebrow down even further, exaggerating a tired appearance. (See article on the subject of eyebrow position and facial expression.)

The Solution

In this case, a brow lift is fundamental to achieving an aesthetically pleasing result. This will not only return the eyebrows and eyelid skin to a more youthful appearance, reduce forehead wrinkles, and create a rested expression, but it will also anchor the brow to minimize further descent of the eyebrows. If there truly is excess eyelid skin after restoring the eyebrows to their normal position, then a pinch of skin can be removed to minimize eyelid fullness.

It should be noted that a percentage of the population would, in fact, benefit solely from removal of upper eyelid skin without a brow lift. These people do not have significant sagging of the brow and forehead and tend to fall into two categories. They inherited upper eyelid fullness with excess skin, usually apparent by the 20s or 30s. Or they are in the 60s, 70s, or older and the skin has lost elasticity or has been stretched from rubbing the eyelids.

Significant excessive upper eyelid skin can interfere with vision. With appropriate documentation and approval, insurance may cover the costs of a functional blepharoplasty to restore vision. Eyelid surgery performed purely for aesthetics or for a condition not severe enough to warrant insurance coverage is considered cosmetic blepharoplasty.

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Dr. Jonathan Hoenig provides the most advanced and innovative techniques in facial plastic surgery and facial rejuvenation today. To learn more about facial plastic and reconstructive surgery, visit us on the web at http://www.la-plastic-surgery.com, email info@drhoenig.com, or phone toll free 866-HOENIG9.

Copyright © 2002-2004, Jonathan Hoenig, M.D., All Rights Reserved
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