Facial aging is often first visible around the eyes. Droopy, heavy lids, extra skin, bags and undesirable fullness around the eyes can lead to a tired or upset appearance. Cosmetic changes often go hand-in-hand with functional changes in the eyelids; excess tissue in the upper eyelids can obstruct vision, and patients who undergo eyelid surgery can often see better while looking better as well.

Treatment of the aging or heavy eyelids can be performed via several approaches:

1. Botox and Dysport – In some patients, treatment of the forehead and smile lines around the eyes can allow for a slight lift of the brow’s tail and a rejuvenated appearance to the eyelid. Subtle and natural, this “Botox brow lift” can do wonders for opening the eyes. Not appropriate for all patients, this treatment must be carefully tailored to each person’s individual anatomy.

2. Injectable fillers – Some dermal fillers may be used to sculpt the upper eyelid and eyebrow ridge. While this does not actually elevate the brow, additional volume below the brow can result in less shadowing around the eye and an overall rejuvenated brow and eyelid appearance. Fillers are frequently employed in the lower eyelid, to camouflage depressions called tear troughs and smooth the appearance of lower eye bags. Most injectable fillers last 1-2 years in the area around the eye, and can at times prove a result that rivals surgical outcomes.

3. Skin resurfacing of the eyelids – Lasers, radiofrequency skin tightening, and chemical peels may improve the texture and tighten the skin of the eyelids. Mild skin excess and crepey skin around the eyes may be well treated with skin resurfacing.

4. Eyelid Surgery (also called Blepharoplasty) – While non-surgical options such as Botox and Dysport and dermal fillers can bring about great improvements around the eyes, blepharoplasty or eyelid surgery may be the best option for some eyelid concerns. Blepharoplasty is a powerful technique for facial and eyelid rejuvenation, and is one of Dr. Fishman’s favorite surgeries for a youthful and natural result.

Age-related changes in the eyelids usually appear in the third decade, and Dr. Fishman often performs blepharoplasty eyelid surgery on patients in their late 30s and 40s. Depending on anatomy and aesthetic desires, some patients may combine eyelid surgery with brow lifting, forehead lifting, lasers or chemical peel skin resurfacing, and facelifting.