Eye Agers

SERVING MANHATTAN AND NEW YORK CITY

There are a variety of eye-area concerns and issues, but you can get drastic results that will change your looks-and your life-without significant pain or downtime.

A Nonsurgical Browlift
Strategically placed BOTOX® injections can give your brows a subtle yet temporary lift-with none of the recovery or downtime associated with surgery

Crow's-Feet Prevention
Regular use of BOTOX® can stop the muscle contractions that lead to the lines, and you may have ageless eyes for years to come.

Under-Eye Bags
Whether caused by genetics, aging or lifestyle factors, send your under-eye bags packing with injectables or surgery.

57% of all blepharoplasty procedures done by facial cosmetic surgeons in 2006 were performed on patients between the ages of 41 to 60.

Vision Correction
If glasses are standing between you and alluring eyes, vision correction surgery is a fast way to start seeing straight.


BOOST YOUR BROWS PERMANENTLY
Permanent makeup involves tattooing small strokes of color onto your arch area to simulate the appearance of eyebrows. Before this procedure, a topical numbing cream is applied to skin, and whether you feel anything depends on your threshold for pain. "Some patients fall asleep and others are a bit jumpy," explains Deborah Vinci, a permanent makeup artist in Scottsdale, Arizona.

Problem
SPARSE LASHES AND BROWS

HAIR TRANSPLANT

HOW IT FIXES THE PROBLEM - "Individual hairs are trans­ferred from the back of the scalp (because these are the same in size and texture] and implanted into your upper eye­lids or brows," explains facial plastic surgeon Jeffrey Epstein, MD, of New York City and Miami.

WHAT TO EXPECT - Anesthesia generally involves an oral sedative and injections of local anesthesia before about 300 hairs land the follicles] are taken from an inconspicuous donor site and transplanted into the brows in a two- to two-and-a-half-hour session. For a lash transplant, between 20 and 40 hairs are implanted in an hour to an hour and a half. The hairs are then trimmed to the appropriate length. "Because of the anesthesia, you shouldn't feel any pain during the procedure," says Dr. Epstein, who also notes that recovery is generally comfortable as well.

WHAT YOU'LL NOTICE - Skin may be a bit bruised and swollen when you leave your doctor's office, but lashes and brows will immediately look fuller. In the brow area, you may also get a small amount of scabbing. "In about three weeks, these hairs fall out because they go through a shock phase and in two to three months they grow again," says Dr. Epstein. The transplanted lashes and brows grow just like the hair on your head, so keep in mind they need to be trimmed regularly. This procedure is not risk-free: Numbness and scarring are : possible. To keep these risks to a minimum, be sure to select a specialist who has extensive experience with these types of hair transplantation procedures.

AFTER PERMANENT MAKEUP
You'll leave the appointment with new brows, but you may be slightly red or swollen in the area (plus a little greasy from the ointment you need to use for the first few days). The color will be a bit darker than the final result, which you'll see in about four to five weeks, when you may need a touch-up. Cosmetic tattoos tend to fade overtime [with darker colors lasting longer than lighter ones), so you may need to have your brows redone in one to five years.

Problem
SAGGING BROW

BROWLIFT

HOW IT FIXES THE PROBLEM - The muscles that contribute to a low brow or create a "hood" over the eyelids are removed or repositioned and secured in a more youthful spot. This procedure can be performed in several ways: Your surgeon can take an "open" approach with an incision across the crown of the head just at or within the hairline (which is necessary if excess skin will be reduced), or a browlift can be performed endoscopically with the assistance of a surgical scope through small incisions at the temples, within the hairline or in the upper eyelid crease. "The endoscope magnifies the tissues so the doctor can see them better," says Salt Lake City plastic surgeon Renato Saltz, MD. "And because it's less invasive than traditional browlift surgery, the scars are smaller." But the approach your cosmetic surgeon recommends for you depends on your individual concerns and goals, and La Jolla, California, plastic surgeon Robert Singer, MD, who uses a variety of techniques to individualize treatment, finds the endoscopic approach to be better suited for those patients who don't have deep horizontal lines across the forehead or a lot of looseness in the skin of the forehead. The bottom line: "You have to tailor the procedure for the goals the patient wants to achieve as well as the tradeoffs they are willing to accept," says Dr. Singer. "In the hands of a good surgeon, you can get a natural-looking result."

WHAT TO EXPECT - After intravenous sedation or general anes­thesia is administered, your surgeon makes the incisions to address the muscles and move the brows to a more desirable position. You may be instructed to wear a tight pressure dressing around your brow area for the first two or three days after surgery, and during the next few days any bruising and swelling should begin to improve.

WHAT YOU'LL NOTICE - Within a week or less, you'll see a higher, more youthful-looking brow. "After about two to three weeks of initial swelling, the brow settles and begins to look more natural," says Dr. Saltz. Some patients complain of mild headaches post-op, but these are well managed by medication and usually subside after a couple of weeks.

Problem
Sagging Brow

BOTOX

HOW IT FIXES THE PROBLEM - Botox relaxes the muscles that are pulling the brow down. "There are two muscles in this area. By treating the one that pulls the brow down with Botox, the opposing brow muscle elevates," says New York City ophthalmic surgeon Basil Pakeman, MD.

WHAT TO EXPECT - In this 10-minute procedure, your doctor will administer several strategically placed injec­tions. You may be asked to make certain facial expres­sions, and you will likely feel a little prick and possibly some stinging or burning.

WHAT YOU'LL NOTICE - Within seven days, you'll see a slight, natural elevation of the brows, and results last from four to six months. For more about appropriate injectable providers, see page 140

Age 38. Facelift, browlift, upper and lower blepharoplasty. Procedure performed by Carl Lentz, MD; Daytona Beach, FL.


FIXING THE UPPER EYELIDS WITH FAT
Hollowness between the upper eyelids and brows can result from heredity or previous eye surgery, but there is a solution. First, a small amount of fat is taken from the abdomen, inner thighs or hips, but unlike larger fat transfer procedures, Raleigh, North Carolina, plastic surgeon Michael Law, MD, explains that "even the thinnest person has enough spare fat for this procedure.' The fat is then processed and placed in the area that needs to be filled.

before eyelid surgery...
I haven't been happy with my eyes since my twenties, and after 30 years I finally decided to do something about them. Although I am so thrilled with the results, there are a few things I wish I had known beforehand.

Out of sight - Much of what I was told to expect after surgery had to do with pain and how I would look. Pain wasn't an issue, and I wasn't really bruised or swollen either, but my vision was blurred for the first few days. I wasn't able to read or watch TV, and since I wasn't sick, I couldn't sleep either! My advice: Books on tape!

Lash out - During the first week after surgery, some of my eye­lashes fell out. They eventually grew back, but it was disconcert­ing to say the least!

Problem
DROOPY, CREPEY UPPER EYELIDS

BLEPHAROPLASTY

HOW IT FIXES THE PROBLEM - "Blepharoplasty can remove the excess skin that is causing hooding or drooping over the eyes," says Dr. Epstein.

WHAT TO EXPECT - Local anesthesia with intravenous sedation or general anesthesia is administered for this procedure, which can be performed in an office-based surgical suite, hospital or ambulatory surgical facility. Incisions are made in the crease of the upper eyelid, so fat and muscle can be removed or repositioned, and excess skin may be reduced. Stitches are used to close the inci­sions, but once they've healed, the scars should be nearly undetectable. Most blepharoplasty patients are surprised by the lack of pain associated with the procedure. A very small percentage of cosmetic surgeons use external sutures to suspend the eyelids as they heal. Your doctor will fully explain where any sutures to close incisions or for suspen­sion will be placed, and when they will be removed.

WHAT YOU'LL NOTICE - After five to 10 days, most of the swelling and bruising will go away and you'll start to see younger-looking, more uplifted eyes. It's important to fol­low your cosmetic surgeon's post-surgery instructions to ensure good healing, and this includes using any eye drops or ointments as prescribed. After about a week, you'll be ready to face the world—but be sure to keep your eyes protected with sunglasses when outdoors.

Age 50. Facelift, coronal browlift, upper and lower blepharoplasty, chin implant, fat injections to the lips, nasolabial folds, marionette lines and jawline. Procedure performed by Carl Lentz, MD; Daytona Beach, FL.

THE RESULTS OF FAT INJECTIONS
Patients see restored fullness to the upper eyelids and the appearance of an elevated brow—with or without the actual browlift surgery. Expect to be somewhat tender for the first week after the treat­ment, and it can take up to two weeks or more for the swelling to subside. Patients are generally back to work one week after the procedure.

AGE PREVENTION POINTER
Peter Thomas Roth Mega Rich Intensive Anti-Aging Cellular Eye Creme - This age-reversing cocktail of active ingredients contains vitamins A, C and E to nourish the skin, plus peptides and retinol to improve deep wrinkles and lines as well as under-eye puffiness.
$65; peterthomasroth.com

Problem
CROW'S-FEET

BOTOX

HOW IT FIXES THE PROBLEM - "Muscle movements are the main cause of crow's-feet," says Dr. Pakeman. Botox mini­mizes the movements of the facial muscles that make these lines and wrinkles.

WHAT TO EXPECT - Your doctor may or may not use a topical numbing cream and will make several strategically placed injections around the outer eye area. You'll feel some small pricks during this approximately 10-minute procedure.

WHAT YOU'LL NOTICE - You may have some bruising right after the procedure. "You'll start to see less movement in the area shortly after, and the maximum results in about a week," says Dr. Pakeman. As the muscle contractions taper off, you'll also see some softening of any existing crow's-feet, but deeper etched lines may require resurfacing for significant improvement.


WHAT - WISH - KNEW
before injectable treatment...

When I went for my first under-eye injectable treatment, my doctor recommended I start with hyaluronic acid since it's reversible, in case I didn't like the results. Nothing surprised me about the treatment itself, and I didn't feel much because of the numbing cream. But I wish I had been more prepared for what I experienced afterwards.

Homeward bound I was told to keep ice packs on my eyes to keep swelling to a minimum, so it would have helped if I had someone to drive me home.      

Perfect timing Sitting upright after treatment also helps keep swelling at bay, so next time I'm going to schedule my treatment first thing in the morning so I don't worry about laying down too soon.   

Delayed reaction For the first day or so I didn't think I was going to bruise, but two to three days after treatment I looked like I had black eyes! About a week after treatment the bruising started to turn green and then yellow, and only then did it start to fade.

The Root of The Problem

Under-eye issues can have environmental causes such as allergies, lack of sleep or a poor diet. There's a genetic component as well, so you may have your DNA to blame for hollows or bags.

AGE PREVENTION POINTER
Jane Iredale Active Light Concealer

When covering up under-eye bags and circles, you need a product that not only conceals, but affects how light reflects off the skin as well. Active Light creates a soft-focus effect and contains vitamin K to minimize the appearance of discoloration, along with cucumber extract to treat inflammation and antioxidant green tea extract to protect against further damage. $25; visit janeiredale.com for retail locations

UNDER-EYE BAGS

LOWER BLEPHAROPLASTY

HOW IT FIXES THE PROBLEM - This procedure can be used to remove the excess fat that causes under-eye bags, or to correct a hollow appearance caused by a lack of fat.

WHAT TO EXPECT - During this procedure, your doctor makes an incision inside your lower eyelid to redistribute or remove the excess fat. If necessary, the muscles and tendons can be addressed through this incision to reshape the eye. And if excess skin is an issue, An incision can be made right under­neath the eyelashes through which it is removed," says Dr. Epstein. Dissolvable stitches are used to close the internal inci­sion and external stitches are generally removed within five days. Once healed, the incisions should be barely detectable. Expect to be swollen and bruised for seven to 10 days or more, and be sure to wear dark glasses and sunscreen to protect your eyes and the healing tissues after surgery.

WHAT YOU'LL NOTICE - When swelling and bruising begin to subside, you'll start to see smoother, less puffy under-eye skin. However, your appearance will continue to refine over the com­ing weeks and months. The final results can turn back the clock on your appearance by about eight to 10 years.

Lower blepharoplasty with lateral retinacular canthoplasty. Procedure performed by Steven Fagien, MD; Boca Raton, FL.

Age 44. Upper and lower blepharoplasty. Procedure performed by Trevor Born, MD; Toronto, ON.

Problem
HOLLOWS UNDER THE EYES

INJECTABLES

HOW IT FIXES THE PROBLEM - Dermal fillers like Restylane or Juvederm fill the area with injectable hyaluronic acid. "This attracts water to the area and results in a plumping of the tissue," explains Dr. Pakeman. A patient's own fat [which can be either injected or grafted during lower eyelid surgery] can also be used.

WHAT TO EXPECT - After your under-eye area is numbed with a topical numbing cream, your doctor will inject the hyaluronic acid filler where the cheekbone meets the tear trough just below the area prone to crow's-feet. How much pain you feel depends on your pain threshold, as well as how numb you get. The whole procedure takes about 15 minutes per eye. For more about fat injections, see the NewBeauty Glossary

WHAT YOU'LL NOTICE I Right after the procedure, your under-eye area will be a bit swollen and possibly bruised. "Once this subsides in five to 10 days, the hollow area will be filled in and any dark circles you had may look better since they're often caused by a shadow on the hollow area," says Dr. Pakeman. Hyaluronic acid injection results can last from six months to a year due to the minimal movement of the under-eye area, while 30 to 50 percent of fat injected will remain permanently.


(Eye) - SIGHT

 

 

The biggest risk associated with vision correction surgery is under-or overcorrection. Be sure to talk to your surgeon about his or her experience with these complica­tions specific to the treatment recommended for you.

AGE PREVENTION POINTER
Postpone the signs of aging in the upper face with a good pair of sunglasses. Fortunately, bigger is better when it comes to protecting your eyes and being fashionable this season. Make sure your frames are large enough to cover the skin surrounding the eyes, especially where crow's feet form. Also look for special lenses that protect your vision by blocking out at least 99 percent of the sun's harmful UVA and UVB rays.

Problem
POOR VISION

VISION CORRECTION SURGERY

HOW IT FIXES THE PROBLEM - Vision correction surgery uses lasers to reshape the cornea, which in turn improves your vision.

WHAT TO EXPECT - During your initial consultation, you will be given a complete eye exam. "This is to make sure that you're a candidate for the procedure," explains New York City ophthalmic plastic sur­geon Joseph Eviatar, MD. Those who have extreme nearsightedness associated with thin corneas may not be candidates, according to Dr. Pakeman, but he explains that there are a variety of techniques that are used to address different sight issues. "Since we have so many technologies to choose from today, we select the best one based on which will offer the greatest degree of safety and improve­ment for the patient."

If you are a candidate, measurements and maps of your cornea are made. If you don't wear contacts, you can have vision correction sur­gery as soon as the next day. If you do wear contacts, you need to go at least 10 days without wearing them before undergoing the surgery. The day of the procedure, the eye tests are repeated. Next, you're given numbing drops and possibly an oral sedative before the ophthalmic surgeon uses lasers to reshape your cornea and smooth out all its bumps and irregularities. "As a result, 30 percent of people see better than they did with glasses or contacts," says Dr. Eviatar. During the 10-minute-per-eye procedure, you may feel pressure on your eyeball for about 30 seconds and see flashing lights.

WHAT YOU'LL NOTICE - "Right afterward, your vision will be a little blurry as if you're seeing things underwater," says Dr. Eviatar, who suggests patients go home and sleep for three hours post-surgery. Within a day, your vision is improved and in the next three months, it will keep getting better. During that time, occasional blurry vision or dry eyes are common. Some patients may also experience blood­shot eyes as well. For more about vision correction surgery, see the NewBeauty Glossary

IS VISION CORRECTION PERMANENT?
For the most part, "If your vision is stable before surgery, it should be stable after surgery as well," explains Dr. Pakeman. This is why your doctor will take a thorough vision history to ensure that your results last after treatment.

LONG-TERM RESULTS
Remember that your eyes will continue to age naturally, even after vision correction surgery, so don't expect perfect vision for the rest of your life. But, the procedure can be repeated down the line, provided the cornea is thick enough.

WHAT - WISH - KNEW
before vision surgery...

When I went to see my eye doctor two years ago, I was diagnosed with a condition called giant papil­lary conjunctivitis that caused bumps on the inside of my eyelids. Because this was caused by wear­ing contacts and it would continue to worsen if I kept wearing them, I was told that I could get vision correction surgery or have to wear glasses for the rest of my life. After hearing that, I went for the surgery.

I didn't experience anything unex­pected, but I didn't realize how careful I would have to be after surgery. I was told to sleep with goggles on for the first week to protect the healing tissue and I was given drops to use during this time as well. I was told to avoid cleanser, face cream and makeup, not only to avoid getting anything in my eyes, but to prevent any rubbing that could potentially damage the healing flap.

I had follow-up appointments one week, one month and then every three months afterwards when my ophthalmologist gave me vision exams to check my progress. Now I go once a year for an annual check-up and I've thrown away all of my glasses and contacts since I now have 20/20 vision. I'd do it all again in a sec­ond, and I recommend the surgery for anyone who wants to ditch their glasses and contacts forever!

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