The first place human connection happens is through the eyes (unless, of course, you live in Los Angeles, where people prefer to look over your shoulder). The eyes are where we search for signs of sincerity and trust. And they also happen to be the first place signs of aging tend to show up. (Even Marilyn Monroe, a certified bombshell, observed that “gravity eventually catches up with all of us.” God forbid any of us start to look our age, even if someone’s barely pushing 30 in this town).
Botox and filler have been short-term saviors for sagging skin, wrinkles, and reducing the signs of aging. These days, however, folks are opting for surgical procedures to achieve long-term results. There are several different kinds of surgical eye procedures—also known by its sexier medical term, blepharoplasty—to consider, which remedy saggy, droopy eyelids and under the eye as well. Cosmetic eye surgery in particular is one of the first surgeries people consider to make them look more youthful and refreshed. Moreover, the downtime and pain involved is surprisingly minimal compared to other procedures.
We sought the input of the top cosmetic eye surgeons (all of whom are revered, if not canonized, in their field by both peers and patients) for the best eye care tips and answers to commonly asked questions. If you’re looking for an alternative to Botox and filler, their expertise will serve you well.
Michael J. Groth, MD
The gist: Stop rubbing your eyes excessively, and use sunscreen and retinol. It really does help.
His global peers like to refer to him as “The Eye God.” Groth is the most prominent cosmetic eye surgeon, hands down. The board certified ophthalmologist with specialty in plastic surgery has an off-the-charts roster of renowned patients, not to mention a one-year waitlist. His technique is precise, clinical, and respected across the globe.
“The eyelid skin stretches and loses elasticity faster than any other skin on the body,” Groth tells W. “It is not uncommon for people in their late 40s to have 30-40 percent more skin on their eyelids than they had when they finished high school. You can only imagine how unsightly it would look if you had 30-40 percent more skin on your face or the rest of your body. The eyelid skin stretches with recurrent swelling, rubbing, and the simple micro trauma of applying and removing make up or putting contact lenses in and out daily. In general, there is more stretching of the upper eyelid compared to the lower eyelid skin because of the greater degree of movement of the upper eyelids.
“A good sunscreen is often the basis of any good skincare regimen to preserve the eyelid skin quality. The best sunscreens include a mineral base, such as zinc oxide, which can be virtually colorless or tinted if desired to protect the eyelid skin. It is particularly important to apply sunscreen to the lower eyelids and cheeks, which get the most direct sunlight and are prone to wrinkles and skin cancer. Retinol products can also be useful on eyelid skin. In fact, eyelid skin frequently responds better than the rest of the face to these products. It is important to proceed cautiously with the use of retinols around the eye as they can lead to an irritant dermatitis manifested by redness and flaking more readily than elsewhere on the face. It is also important to avoid getting the retinol products in the eyes, as the mucous membrane of the eyes are sensitive to these products. When the upper lids start to droop due to a weak or disinserted upper lid levator muscle, we occasionally use a newer product called Upneeq: a drop placed in the eyes raises the upper lid for up to 8 hours.”
Dr. Robert Schwarcz
The gist: Lighter-weight products for the eye area work best.
Consider Schwarcz the Groth of the East Coast. The renowned Manhattan-based double board-certified oculofacial plastic surgeon, Dr. Robert Schwarcz, has patients come from all over the world to be treated by him for his signature eyelid lifts. He’s one of the most sought-after plastic surgeons for his skill and artistry in creating a natural-looking, more youthful eye.
“Consider lighter products in the area, and choose ones that will reduce puffiness in the skin,” he suggests. “It’s most beneficial to use products that are less hydrophilic in the eye area so as not to cause swelling. The eye is the most sensitive area of skin across the entire body, and the eye area is where puffiness and swelling can be more obvious. It also does not have as many oil glands and does not produce as much collagen as the rest of the body, which makes it more sensitive to signs of aging like dryness, droopiness, dark circles, fine lines, and wrinkles. The eye area is also sensitive to any overfilling or pulling and can show these signs in an obvious manner. Filler can add beautiful volume and fullness to the eye area without looking overdone. Patients love it for how natural they look after treatment.
“I also routinely use autologous fat, where we remove unwanted fat from other places in the patient’s body and inject it into the eye area. I developed Orvos Satin Eye Gel Cream after 4 years of research as a plant-based alternative. It uses bakuchiol, which is an alternative to retinol with similar benefits, making it ideal for the sensitive eye area. It is also infused with green tea extract to calm irritation and de-puff, and coffee seed extract to help retain moisture. Finally, it has Kakadu Plum extract, which contains up to 55 times the vitamin C as in oranges, and has natural antioxidant properties to restore skin elasticity and protect from free-radical damage.”
Guy Massry, MD
The gist: Too much filler can do more harm than good for the eyes.
Massry—a Beverly Hills-based, USC-trained eye surgeon—has a 25-year practice with over 100 published manuscripits and textbook presentations on ophthalmic plastic and reconsturive surgery. More importantly, he’s actually the doctor other esteemed eye surgeons go to when they want to get their own eyes done.
“Fillers are a great tool for smoothing of the lower lid cheek transition (filling hollows or depressions), however not everyone is a good candidate,” Massry says. “Fillers are like sponges—they imbibe fluid, which leads to their expansion and their clinical affect of filling. The problem is, in the lower eyelid, the skin is so thin any irregularity will show up. This can manifest as lumps and bumps, color change (what we call “dyschromia”) and swelling. This is especially true with repeat injections. It is important to only have filling done by experienced injectors who understand the dynamics of how fillers behave in the lower lids.”
Dr. Andrew Frankel
The gist: Botox can only help so much.
Frankel has long been recognized as one of the most prominent plastic surgeons—for both the eyes and the rest of the face. His Beverly Hills practice has long been hailed as the go-to place for facial rejuvenation. His technique has always been subtle, but also extremely balanced and complimentary.
“Neurotoxin injections (Botox, Dysport etc.) can help prevent development of lines associated with underlying muscular contractions,” Frankel says. “However, the injections must be done with thoughtfulness and skill to maximize the benefits without creating an undesirable change in the smile. When one section of a muscle is paralyzed, the unaffected muscle fibers tend to contract more forcibly in compensation, and that can either be used beneficially or contribute to more lines in unwanted areas. Sun protection is a must, as is avoiding smoking. I find filler very helpful in certain patients who are developing excess, crepe-y skin in the upper or lower lids due to volume loss. There has recently been much interest in nanofat injections as a rejuvenating treatment as well; and although all the details have yet to be standardized, that has promise.
“At some point, though, all of the above can only do so much. Surgical options are a personal decision. Surgery does not necessarily make everything look perfect and there are potential negative consequences. It’s always best to move forward when the benefits far outweigh the risks. The lower lid is particularly prone to retracting or everting if an incision heals with tension. Often, when a patient has many fine lines and textural issues as the primary complaint, surgery is not a great option because it does not improve skin quality, even if it’s done well and heals without a problem.
“I think lower lid surgery is most effective when it’s addressing contour issues rather than the skin. Upper eyelid surgery carries less risk, and I am more agreeable to surgery for the upper lids to remove skin and/or muscle when indicated, and to reposition some fat. It would be incomplete to omit brow lifting as part of this discussion, since often the upper lid issues are due heaviness of the eyebrows and thicker brow skin. I frequently combine endoscopic brow recontouring with upper blepharoplasty to optimize the results.”
Shoib Myint, MD
The gist: Nano fat for periorbital rejuvenation is an effective procedure with excellent results.
This board certified oculofacial plastic surgeon has clinics in Madrid, where he frequently treats European royalty—and caters to the jet set abroad as well, with offices in Beverly Hills and Las Vegas. Myint is fellowship trained in ophthalmic plastic and reconstructive Surgery by one of the pioneers in his specialty. His Mentor, Dr. Frank Nesi, was the prodigy of Dr. Byron Smith, who invented the specialty of oculoplastic surgery. Dr Myint has been teaching other doctors from around the world and has authored and co-authored five of the leading textbooks in the field of ophthalmic plastic and reconstructive surgery.
“Three life events age the skin around the eyelids: collagen degradation, fat loss, and gravitational pull,” Myint says. “Currently, different modalities are used to correct collagen degradation (wrinkles, loss of tone and texture), fat loss (hollowness under the eyelid, dark circles), and gravity (sagging eyelid and cheek skin). Some of these remedies include: obviously, surgery; eyelid fat repositioning; hyaluronic acid gel volume augmentation; PRP; microneedling; nonablative, and ablative lasers. I’m also incorporating nanofat and microfat technology because I have seen amazing results with my patients. Not only does fat provide structural changes but also regenerative capabilities. I perform liposuction of fat cells from the patient’s abdomen or thigh and then process the fat into extremely tiny particles called nano and micro fat cells. Our fat cells carry growth factors, stem cells, stromal vascular fractions (blood vessels), all of which have powerful regenerative capabilities. These cells, when placed under the skin with an extremely thin needle or a cannula, can capture and stimulate new blood vessels which can affect our tissue in so many different ways. Wrinkle reduction, smoother skin, wound healing, and reducing scarring are just some of the benefits.”
Dr. Chaneve Jeanniton
The gist: remember—the timeline for surgical options is personal and individualized.
The Brooklyn-based oculoplastic surgeon has a revered approach that respects the facial architecture of her patients, while correcting and enhancing their own features. Her boutique Brooklyn office conducts thorough consultations and procedures to make sure the patient looks their best.
“The decision to undergo surgery is a very personal and individualized one,” she says. “I’ve operated on patients in their 20s and on patients in their 80s for aesthetic eye concerns. The decision to undergo blepharoplasty, aka cosmetic eyelid surgery, is based more on anatomical considerations than on age. Here’s some general advice for how to approach this decision, though. For the upper lids, if you’re dissatisfied with the appearance of sagging or extra skin on the lids or perhaps noticing drooping of your eyelid(s), chat with a specialist. For patients presenting with these signs, I’ll assess their candidacy for a Botox brow lift. If that helps lift the weight of the skin off of the upper lids, that’s a great option to keep someone happy without surgery. For a droopy eyelid, we can explore whether a prescribed eye drop like Upneeq is a viable solution to providing lift. When it comes to the lower lids, if filler isn’t able to effectively camouflage undereye bags, considering surgery is typically the next step.”
Kelsey A. Roelofs, MD FRCSC
The gist: Simultaneously addressing the the periocular skin with a laser or peel can enhance the overall aesthetic outcome.
A protégé of UCLA’s Dr. Robert Goldberg—the internationally recognized eye surgeon noted for pioneering several of the most innovative techniques in aesthetic eyelid surgery—Roelofs has been a fast-rising star in the oculofacial surgery world. She completed her residency trained in Canada, England, and UCLA. Her attention to customization and a conservative, less-is-more approach, has won the respect of patients and peers on a national scale as of late.
“Building a surgical plan that pays attention to the small details will pay dividends in the future,” Roelofs says. “For instance, simultaneously addressing skin texture and/or pigmentation with a laser or peel may help maximize the overall cosmetic improvement without significantly increasing your downtime. In addition, when considering options for rejuvenation of the eyes, face, and neck, working together with your surgeon to build a customized approach is key. In my opinion, there is no one-size-fits-all option, especially when it comes to cosmetic eyelid surgery. Bringing photographs of yourself at a younger age to the consultation is often a helpful place to start, as these can be used to build a clearer picture of the goals and limitations of surgery. Finally, keeping the big picture in mind is crucial: the eyelids must be considered in the context of the eyebrow and forehead position, the cheek and mid-face descent and the overall volume deflation of the face. Finding solutions, often by combining both surgical and non-surgical interventions, that harmoniously address these aesthetic units will lead to the most natural and rejuvenated appearance.”