By David S. Kirn, M.D., F.A.C.S.


“People ask me if I’m tired” is one of the most frequent complaints we hear from patients. Age-related changes in the eyes can give the appearance that we are tired, even when we feel energetic. When we look at another person, we normally look at their eyes first. So, having the eyes appear youthful and bright is one of the most important items we address in Plastic Surgery. There are several components of aging around the eyes.

Wrinkles develop around the eyes, known as “crow’s feet.” Neurotoxins, such as Botox® or Dysport® work by decreasing muscle activity so that the muscle does not fold the skin and create wrinkles. Although the effect is temporary, usually 3-4 months duration, the quality, convenience and safety of this treatment are hard to beat.

Development of excess eyelid skin is the hallmark of a tired looking eye.

A surgical procedure known as blepharoplasty is the only effective treatment. For the upper eyelids, blepharoplasty involves removal of extra skin, muscle and fat. The scar is positioned along the upper lid crease. After surgery, patients will frequently comment that the operation “opened my eyes.”

The lower eyelids tend to develop wrinkled extra skin, puffy fat pads, and a tear trough crease (an oblique line which extends downward from the eye). To address these changes, an incision is usually placed just below the eyelashes to allow removal of excess skin and fat. Modern procedures focus on maintenance of volume to avoid a hollow, aged look. Fat may be moved from an area of excess, such as a puffy eyelid, downward to decrease a deep tear trough. The area underneath the eyelid may be restored with transfer of fat from some other body area (fat grafting) or with a dermal filler such as Restylane®, Juvederm® or others. The goals are to smooth the eyelid and blend the transition from the eyelid to the cheek as seamlessly as possible into a youthful contour.

Surgery and injectable medications may be used independently or together. Both should create a natural appearing, youthful eye shape.