The best eye surgery results are ones you can’t tell are surgery, says Boca Raton, FL, oculoplastic surgeon Steven Fagien, MD. Past techniques for eyelid lifts left patients looking “done” and “different,” but with an advanced approach that work a patient’s facial anatomy that addresses main concerns without leaving an unnatural look, he’s been able to achieve results that improve the appearance in the most natural-looking way.
An Approach for Aging Eyes
An eyelid lift surgically redefines the youthful shape of the eye. “The past technique was to take out skin, muscle and fat and that was the traditional solution,” he explains. “So, you took somebody who had a youthful look before, but at a later age, when they lose a good part of the youthful qualities, they undergo this procedure where too much skin, fat and muscle was removed. While they may have improved in some ways, they didn’t necessarily look younger or their very best, defied detection, or in my opinion, look prettier.”
Using a more conservative and anatomic approach, Dr. Fagien aims to preserve most of the fat, all the muscle and precisely removes the exact amount of excess skin needed and reforms the crease and eyelid fold at a level that appears more youthful. “If the incisions are made too high, which they typically have been, the skin does funny things and tends to migrate higher towards the eyebrow and are visible. My concept was to put the crease at a more natural, lower level.” Preserving more fat helps retain a younger look, says the surgeon, as fat loss and shifting will continue to occur as we age.
“Tightening the Hammock”
Using his canthoplasty, or reticular suspension, Dr. Fagien lifts the outer corners of the eyes, corrects drooping eyelids, and provides extra eyelid support after lower blepharoplasty. To put it in layman’s terms, a canthoplasty is like lifting the hammock across your lower eyelid, he explains. “You know when you take your finger, and you pull your lower eyelid over to the right on your right side – towards the outer part of your eye – and you see that this looks so much better? The reason it looks so much better is because you’re tightening the hammock by tightening the muscles or ligaments that support the lower eyelid to the outer corners of the eye. This is what my procedure does.”
Lower Eyelid Repair
For hollow, sunken-in eyes, under-eye bags, dark circles or tired-looking eyes, Dr. Fagien has a similar approach to his upper eyelifts. “Rather than making a deep incision under the lashes to get under the skin and muscle, which is what is commonly done for removal of both layers, I don’t go under the muscle. If you tighten the skin and muscle together, the skin more often remains wrinkled. You also lose the ability to use the muscle as additional support to the lower eyelid. As we age our skin doesn’t hold as tightly to the muscle as it in our 20s, 30s or 40s.” This method regains the attachments of the skin to the underlying muscle making the skin appear smoother. Using a specific technique called transconjunctival blepharoplasty, he removes or repositions fat in the eye-area fat through invisible incisions made inside the lower eyelid. “If more skin needs to be tightened, an additional incision is made just beneath the lower lash line. After the skin and fat are addressed, the tissues are reshaped by muscle suspension and repositioned as needed to create a smooth contour between the lower eyelid and cheek,” he explains.
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