There are a number of changes that occur to the eyelid and surrounding structures as a result of normal aging. Overall, there is descent and deflation of the tissues. There is loss of volume and downward movement of the soft tissues and bone, sun damage to the skin resulting in hyperpigmentation and uneven skin tone, and wrinkles.
Often the brow descends over time, particularly along the outer corners. This can cause not only a “tired” or “angry” appearance, but can also cause the eyelid skin to droop over the eyelids (ptosis) and block one’s sight. This can be reversed by injecting Botox directly underneath the brow. The Botox weakens the muscle that naturally lowers the brow, thus creating a Botox brow-lift. For more severe cases, surgery may be necessary to suspend the brow back to its original location.
The skin and soft tissue of the lower eyelids are also subject to aging changes. In some people there is a hollowing of the area, called the tear trough. This volume can be restored by dermal filler (i.e. Restylane) or by fat grafting, where a patient’s own fat is taken from another part of the body and injected under the skin of the lower lids. In other people the normal fat around the eye descends and creates “bags.” This is best treated by surgery.
The skin and supportive structures of the eyelid may also weaken with time. The eyelid may even become completely detached from its normal attachments and fall into an abnormal position. The eyelid may turn inwards toward the eye (entropion) or away from the eye (ectropion). This can disrupt the normal functioning of the eyelids, which is to protect the eye and help tears flow naturally. These conditions are treated by various surgical procedures. Your physician will discuss which surgery is best suited for you individually.
Aging can also cause cosmetic concerns, the two most common being wrinkles and sun spots. Wrinkles are the results of a combination of factors including sun exposure, genetics, smoking and the constant act of making facial expressions. Depending on their location, these are treating with Botox and/or dermal fillers. As discussed in other sections, these treatments are temporary. However, if you like the results, there is a new dermal filler, called Artefill, which is permanent. Sun spots and uneven skin tone are treated with a combination of laser treatments and facial skin products. The goal of effective skin care treatments involves exfoliation, resurfacing and regeneration, and sun protection.