Windows of the soul
Dr Maryam Zamani, oculoplastic surgeon, facial aesthetics doctor and founder of MZ SKIN, shares her insights on treatments for the eyes and why the eyes make such an impact on the face overall.
People often come to me with a variety of concerns, such as puffy lower eyelids, dark circles and excess hooding on the upper eyelids. Their goal is to look refreshed and natural with subtle improvements to help them look their best at every age. Harmonious treatments that incorporate the different layers of the skin create the most natural outcomes and can include anything from neuromodulators or hyaluronic acid fillers to surgery.
Tear trough
Volume loss is a common reason whereby the eyelid-cheek junction elongates, exposing the anatomical tear trough and the appearance of dark circles. Often, hyaluronic acid can be injected along this anatomical tear trough at the eyelid-cheek junction to improve this contour. This is an injection that takes minutes to administer and can last between 6-18 months, depending on the type of filler used. I do not recommend using permanent fillers in this area, as there is no recourse if there is a complication. Hyaluronic acid is optimal as it is temporary and potentially reversible (using another injection of an enzyme that breaks the hyaluronic acid down immediately)
Crow’s feet
Lines and wrinkles caused by the movement of the concentric orbicularis oculi muscle can be weakened using botulinum toxin. A few injections in the area can help elevate the lateral eyebrow and can be used to soften those lines and wrinkles. In others a bit of skin hydration with hyaluronic acid can be used to improve skin quality. Of course, good skin care is of utmost importance. There isn’t much downtime, and the results are pretty instant!
Eyelid Area
Upper eyelid blepharoplasty is the gold standard for removing excess skin and medial fat from the upper eyelids. In younger patients that have only a small amount, I recommend a combination of injectables and sometimes a bit of Ultherapy to help tighten the skin in that area.
Dark circles
Dark circles are a common complaint in my office and can be caused by so many different reasons. One of the most common reasons for dark circles is loss of volume in the periorbital area. As we age, the eyelid-cheek junction becomes more prominent and where this junction was once confluent in youth, it becomes demarcated, giving the appearance of dark lower eyelids, sometimes referred to as eyelid bags or dark circles. This can become quite evident even from our 20s and progressively worsens as we age and the facial skin and underlying structures begin to sag. This can be treated with meticulously placed microdroplets of hyaluronic acid to help hydrate and volumise the area, giving an immediate rejuvenating effect to the eye.
Case study
A 63-year-old female (now 64) presented complaining of her eyelid heaviness, difficulty with sight, watching TV and putting on make-up. She expressed an overall feeling of being “tired-looking” and felt exhausted holding her eyelids up. She was also bothered by skin laxity in the periorbital area.
She was really only a surgical candidate. Her eyelids rested on her eyelashes, her lateral brows were low, and she had excess skin in the lower eyelids. I could have opted for surgery to remove the skin on the lower eyelids, but I find that a well-done ablative CO2 laser can achieve improved skin quality and tone without a scar and risk of other complications that can come with a lower eyelid skin excision blepharoplasty.
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The patient’s eyelids were sitting on her eyelashes, she was constantly elevating her brows, and she had skin laxity in the lower eyelids. I opened for an upper eyelid blepharoplasty to address the skin and fat prolapse in the upper eyelid. Brow pexy to help improve the lateral brow and the lateral hooding as well as to help prevent it from further lowering with time. CO2 versus skin excision was discussed. The patient did not want the scar and the potential risks associated with the skin excision.
I love combining both surgery and laser to optimise results for the patient. Having the ability to use different modalities means I can offer them the best service.