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Any suggestions around the eyes; Botox or surgery?

Dr. Dean Kane Q & A botox Q. I am 33 years old and a mother. I lost weight last year (13 kg.) My eyes are a big problem for me. My upper lid looks bulky, sick and down, and my under eyes is puffy and looks so puffy from my face’s side view. Also, I have a deep wrinkle under my eyes which looks like thick excess skin. My questions are how to know if I need full Botox protocol around eyes or it is excess fat surgery and should I start Botox now or is it better to wait? If I need Botox, should I do a full protocol or specific areas? A. ​Weight loss and aging are not kind around the eyes but there are many options depending on what you wish to achieve. I have listed below the general changes in facial aging. ​Below that are considerations for you. Facial Aging are created from the 5 different layers of the skin, fat, muscle and bone. ​ During the first 20 years or so of life, the body genetically determines how to develop and repair a constantly changing “face” including all these layers (as it does elsewhere in the body). Thereafter it remains robust in repairing itself from injury but the accumulation of environmental, health and nutritional exposure will add to the passive inability for the body to care for itself after 30. This is when physical changes such as skin laxity, irregular pigmentation, lines and wrinkles and skin diseases occur. We now have many options to rejuvenate the layer or layers of the face which need care or stimulation to reverse the aging trend. 1. The top layer or stratum corneum of the epidermis is the rough, pigmented layer of the skin; creating most of the depth of the wrinkle.
  • Exfoliation is best for this using:
  • microdermabrasion,
  • Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis,
  • Some lasers and chemical peels.
  1. The second layer is the dermis which thins with aging. The natural collagen, elastin and hyaluronic acid (which hydrate and toughen the skin) are thickened by the use of:
  • fillers (Restylane and Juvederm), or
  • Retinoids (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper dermal skin cells.
  • Sculptra properly managed is the latest sensation in stimulating firming and thickening of the dermis
3. The next layer or fat also thins or droops with age and maybe:
  • filled (Restylane and Juvederm), fat grafting or
  • redraped (threadlift, short-scar, traditional, endoscopic face / neck / brow lifts / cheek)
  1. The muscle which creases the skin into wrinkles and folds is weakened and rebalanced with
  • Botox or similar injectable muscle relaxers like Dysport or Xeomin.
  1. Bone also undergoes a dynamic process of resorption, thinning and descent. Options for cosmetic enhancements include:
  • implants
  • structural fillers, particularly like Radiesse (bone mineral)
  • volumizing gel fillers like Juvederm and Restylane
Facelift, necklift and forehead lift are surgical procedures which include:
  • an incision along the periphery of the tissues
  • a suspension or re-positioning of the underlying soft tissues, and
  • a redraping of the skin with removal of skin excess.
A sub-group to the facelift is the mid-face lift. This is used to detach the soft-tissues of the cheek which have descended, separated and lost volume and suspend them to the lower orbital rim. Generally, the fat pockets under the eyes are trimmed or added to the volume of the cheek and the eyelid skin is redraped. ​ ​Consider:
  • ​ Your “before” photo shows beautiful but low brows. You may wish to consider Botox for a non-surgical brow lift, filler for greater lateral brow fill and / or upper eyelid lift to remove any significant skin laxity.
  • ​ The fat and soft tissues have descended and filler in the upper mid and middle cheek in my hands has been very satisfying for patients like yourself.
  • ​Consider retinoids and Sculptra for skin firming and gentle filling as well.
  • ​ A mid-face lift will combine the virtues of a lower eyelid lift and vertically redrape the soft tissue laxity while redraping the nasolabial and at times lower face folds.
Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result. You can understand why it takes a talented individual, preferably a Board Certified Plastic Surgeon or ENT Facial Surgeon with great experience to evaluate your needs and find a plan that works best for you. ​ All surgical, minimally invasive and non-invasive procedures and their combinations should be discussed following a proper examination with a well versed, Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills. I hope this is helpful. Happy Holidays!   This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics. 
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