Surgical and Non Surgical Eyelid Treatments

Non Surgical Treatment for Dark Circles under the eyes and bags under the Eyes (Under Eye Filler)

One of the most common complaints that patients have about their eyes is the appearance of dark circles under the eyes.  Some dark circles can be the result of shadows from bulging under eye fat or bags, or from under eye hollowness. Under eye hollowness can be caused by either a weak cheek bone and deficient orbital rim, or from deficient under eye fat. Frequently, under eye dark circles are the result of lower lid hollowness. This hollowness can even occur in younger patients and is often the result of decreased volume in the lower lid and upper cheek areas. This under eye hollowness is sometimes genetic. Dr. Aharonov has successfully used facial fillers such as Restylane to restore the natural volume and improve the under eye hollowness. Under eye filler injections have minimized the appearance of persistent dark circles. Restylane and other facial fillers can be long lasting, sometimes lasting for years. Under eye filler injection is quick and virtually pain free. Occasionally, in patients with significant amount of fat under their eyes (fat bags), surgery might be the best option. In these patients a lower eyelid lift surgery with fat repositioning may be the best solution to minimize under eye bags and puffiness. Each patient must be evaluated on an individual basis, as there are numerous reasons why a particular person has under eye dark circles. During your consultation, Dr. Aharonov can thoroughly evaluate your specific concern and suggest the best possible treatment for under eye dark circles.

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Before and after under eye filler treatment with Restylane. Notice the improvement in the patient's under eye hollowness and the decreased appearance of her under eye bags.

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under eye dark circles treatment under eye hollowness treatment

Before and after under eye filler treatment with Restylane. Notice the improvement in the patient's hollowness and the decreased appearance of her under eye bags.

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under eye dark circles treatment under eye hollowness treatment

Before and after under eye filler treatment. Notice the improvement in the patient's hollowness and reduced appearance of her under eye dark circles.

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Before and after under eye filler treatment with Restylane. Notice the improvement in the patient's under eye dark circles.

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Upper Eyelid Filler: Non Surgical Upper Eyelid Lift with Fillers

Many times, excess upper eyelid skin is due to volumetric deflation of the upper eyelid and eyebrow area causing the appearance of hollowness above the eye and drooping of the brow.  As we age, we tend to lose fat in this area of the face and eyes first, leading to our eyes giving away our age. Think of how young people and babies are often described as having full round faces, and older people develop gaunt, sunken features. Like a balloon losing air, we develop the appearance of excess skin in the upper eyelid area as the natural volume of facial fat decreases with age. In some situations it is best to cut away this extra Eyelid skin if there is just too much tissue, but most patients will benefit more from re inflating the brow and upper lid back to how it was when they were younger. To do this, Dr. Aharonov can either use a Facial Filler like Restylane, and in a matter of minutes can make the upper eyelid and brow look the way it used to, without surgery. In fact, surgery cutting away eyelid skin in these types of patients might actually make the eyes seem more hollow and skeletal, imparting a more aged and tired appearance, even though there is less overhanging skin.

The minimally invasive Eyelid Lift using facial fillers is done while you are sitting comfortably in a chair. The procedure takes just a matter of minutes, and has an immediate effect. The results of the upper eyelid filler injection can last for years and is probably the most accurate predictable way of restoring volume to the face and eyes. The minimally invasive Eyelid Lift with fillers is a way that your eyes can look years younger in a matter of minutes without surgery or downtime.

Eyelid Lift with fillers can also be used for patients who have had a surgical Eyelid Lift with resulting Eyelid hollowness or eyelid asymmetry. Fillers can be used to create better symmetry in the eyelids.

Eyelid Lift with fillers restores your eyes to a more youthful state naturally and easily. During your consultation with Dr. Aharonov, he will discuss all of your non surgical and surgical options regarding your upper eyelids, brows, face or anything else that might be bothering you. If you decide to proceed with a facial filler treatment, it can usually be done during that same visit. Dr. Aharonov can also show you many before and after photos of patients who have had eyelid filler treatments or eyelid surgery.

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Before and after upper eyelid filler for hollowness above the eye. This patient had early volume loss in her upper eyelid causing her to appear tired and sad combined with upper eyelid ptosis which is droopiness of the actual eyelid. Restylane was used to fill in the hollowness above her eyes, and Dysport was used on her eyelid to help raise it slightly.

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Before and after upper eyelid filler for hollowness above the eye. This young patient had early volume loss in her upper eyelid causing her to appear tired and sad. Restylane was used to fill in the hollowness above her eyes.

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filler in upper eyelid eye lift with restylane treatment under eyes dark circles

Before and after upper eyelid filler for hollowness around the eyes. These results are one and a half years after treatment with Restylane injections above the eye.

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filler in upper eyelid eye lift with restylane treatment under eyes dark circles

Before and after upper eyelid filler for hollowness and droopy skin. Notice how the patient's upper eyelid hollowness is improved and there seems to be less upper eyelid loose skin.

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Non Surgical Treatment of Bulging Eyes or Prominent Eyes with Facial Fillers

Bulging eyes or prominent eyes can be caused by some medical conditions like Grave's disease, or could be something genetic that some people are born with. In some people the eyes can seem to be getting more prominent or more bulging as they age. For people with severe bulging of the eyes, or what is called proptosis, surgery is sometimes the best solution. Surgical options for prominent eyes or proptosis include orbital decompression surgery or orbital rim on lay grafting. These surgeries are fairly invasive and can sometimes have severe complications including to vision.

Proptosis or bulging eyes depends on the relationship between the globe (the eyeball) and the surrounding orbital rim (eye socket). How far anterior the globe or eyeball sits in relation to the orbital rim will dictate the degree of proptosis or prominence of the eyes. This is sometimes symmetric in both eyes or asymmetric with one eye being more bulging than the other.

Orbital decompression involves enlarging the size of the eye socket by fracturing the walls of the orbit outwards allowing the globe (eyeball) to settle further back and have more room so it doesn't bulge as much.

Another surgical option involves building up the surrounding orbital rim (the superior and inferior orbital rims) by placing on lay grafts on them to make the rims project more anteriorly in relation to the globe. This leaves the eyeball in the same position (as opposed to orbital decompression). The eye seems less bulging and less prominent because the orbital rim is sticking out further.

This same concept can be performed non surgically using facial fillers such as Restylane. The facial filler is used to build up the orbital rim (either the inferior, superior or both orbital rims) making the eye look less prominent and less bulging. This is a great option for people with moderate to mild proptosis, bulging eyes, or prominent eyes. It can be used to make the eyes more symmetric as well. This is a painless in office procedure that can be performed in a matter of a few minutes. It is similar in nature to using facial fillers to treat dark circles or under eye bags. It is also a great option for people with orbicularis hypertrophy (having a thick crease right below the lower eyelashes) because this problem is usually caused by decreased support of the globe by a weak inferior orbital rim.

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Non surgical treatment for prominent or bulging eyes. Filler was used to soften the patient's eyes and reduce the retractions of his lower eyelids. This procedure can also be used to correct lid retraction after lower or upper eyelid blepharoplasty.

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Non Surgical Treatment of Sunken Eyes (Enophthalmos) with Facial Fillers

Sunken eye or Enophthalmos is when the eyeball itself is sunken in too deep in the eye socket. It can be either congenital, due to silent sinus syndrome, or post traumatic. It usually affects just one eye. Some people can also just have overly deep set eyes. There are surgical fixes which involve placing grafts deep in the eye socket to help push the eyeball forward. Filler can be used to achieve the same result in the office while the patient is awake. A needle is inserted below the eyelid into the back of the eye socket and filler is slowly injected. The filler acts to push the eyeball further out and help correct the enophthalmos.

What is Eyelid Lift Surgery or Blepharoplasty?

Dr. Gal Aharonov performs Eyelid Surgery or Blepharoplasty to tighten the drooping skin of the upper eyelid or to remove the under eye bags or puffiness of the lower eyelid. In addition to making you appear older, the aging eye can make you appear tired, sad, or angry. This is one of the most common plastic surgery procedures performed for both men and women. It is even performed in younger patients, as the eyes are subject to your genetics. For many young patients, lower under eye bags or droopy upper eyelids run in the family, and these patients will see a dramatic improvement in their appearance and self esteem.

Eyelid Lift Surgery or Blepharoplasty can be performed to improve one's overall look or can cause a functional improvement. Often, a drooping upper eyelid from excess skin or fat can impair one's vision. In addition to the changes associated with aging, hereditary factors, trauma, infection, or inflammation can cause the eyelids to droop or sag. After Dr. Aharonov performs the Eyelid Lift surgery, patients have a more awake refreshed appearance.

Upper Eyelid Lift Surgery (Upper Blepharoplasty)

Sagging skin and excess fat in the upper eyelid can create an aged, tired, or angry appearance. An upper eyelid lift surgery (blepharoplasty) is a procedure that is very effective in correcting this condition. The upper eyelid lift is accomplished by first drawing an incision line in your natural upper eyelid crease. A fine incision is made along the previously marked line in your natural eyelid crease. Dr. Aharonov precisely trims the excess hanging skin, removes any excess fat and sagging muscles are tightened if necessary. The skin is closed with extremely fine sutures, gradually leaving a virtually undetectable scar. The result leaves patients with a smoother, firmer upper eyelid. Your eyes look more awake, alert, and refreshed.

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Upper eyelid lift (blepharoplasty) as well as lower eyelid lift.

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Lower Eyelid Lift Surgery (Lower Blepharoplasty)

Excess fat and skin in the lower eyelid can contribute to an aged and puffy appearance. In a lower Eyelid Lift Surgery (Blepharoplasty), an incision is concealed along the inner surface of the lower eyelid, called the transconjunctival lower blepharoplasty. Dr. Aharonov either repositions or removes excess fat without changing the shape of the eye. If there is hollowness beneath the eye, the bulging fat bags can be repositioned to fill that area, thereby effectively eliminating two major eye complaints. In instances where there is unsightly excess wrinkled skin in the lower eyelid, a well concealed incision is made just under the lash line. The loose lower eyelid skin is trimmed away, creating a tighter, smoother under eye appearance. This procedure is also referred to as a “skin pinch”. As the bruising and swelling subside, the incision line will gradually become virtually undetectable. The lower eyelid and surrounding area will reveal a smooth, firm contour giving you a youthful and vital appearance. Dr Aharonov customizes eyelid surgery to the individual needs of patients.

Wrinkles or Crow's Feet

These are best addressed by Botox or Dysport, as the Eyelid Lift surgery does not treat wrinkles. At the time of your consultation, Dr. Aharonov can discuss all of your options with you. He specializes in Botox and Dysport treatments that smooth the wrinkles and furrows, without leaving you with a frozen unnatural look.

Brow Lift or Forehead Lift

A low positioned brow may cause the upper eyelids to hang lower, obscuring the eyes called hooding. This can also contribute to the aged appearance of the eyes. Depending on the individual patient, a Brow Lift Surgery may be more effective at correcting the problem of drooping upper eyelids, or may be done along with an Upper Eyelid Lift Surgery. Additionally, a Brow Lift Surgery will smooth out lines or furrows on the forehead. There are several ways to perform a brow lift depending on the patient's anatomy and goals. With a Brow Lift or Forehead Lift, the eyebrows are elevated and properly positioned, the heaviness from the upper eyelids is decreased, and frown lines and forehead wrinkles are diminished giving a natural more rested appearance.

Healing After Upper or Lower Eyelid Lift Surgery (Blepharoplasty)

You should expect mild aching or itching after Eyelid Lift Surgery. This mild discomfort is usually well controlled with Tylenol and cold compresses. There will be swelling of the eyelid area, which usually peaks on the morning after surgery. The swelling will mostly resolve over the next ten days to two weeks, but some patients may experience some mild puffiness for a longer period. There are ways to minimize the swelling, including cold compresses, avoiding salty foods and alcohol. Salty foods and alcohol cause your body to retain fluid. Areas of inflammation, like eyelids healing from an eyelid lift, are common targets for extra swelling. Frequently patients report that they appear more puffy in the morning and less in the evening. A moderate of amount bruising after Eyelid Lift Surgery is to be expected. This will begin to fade in several days, and should be gone by two weeks. Most patients are ready to go out in public after about 6-10 days.

Activity Level and Exercise After Eyelid Lift Surgery (Blepharoplasty)

You should relax during the first two days after your Eyelid Lift Surgery. After that, normal daily activities should be resumed, but strenuous activities or exercise should be avoided for about 10 days. Vigorous aerobic exercise and heavy straining or weight training can all increase swelling in the inflamed soft tissues of the eyelids. Light exercise such as walking can be done during this time.

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