When we glance at someone, the first things we see are their eyes and surrounding structures. The eyelids, and specifically the lower lids, attract our immediate attention. The mid-face and the lower lids are two of the facial areas that first age. Elongation of the lower lids and reabsorption of fat are the main reasons for the aging appearance of the lower eyelids. The skin of the lower lids gets darker, and considering that this skin is usually darker than the rest of the face, this dyschromia is even more noticeable. The reason for the darkening of the skin is a matter of debate. However, it is known that thinning of the skin allows visualization of blood vessels in the deeper layers, and the accumulation of pigment makes this problem more noticeable. The skin of the lower lids is also greatly affected by wrinkling secondary to solar damage. These lines usually extend around the eyes, causing what is commonly known as “crow feet.” The herniation or protrusion of the lower lid bags in many patients makes this situation even worse. Traditional blepharoplasty is performed by removing the fat bags and some skin. However, in many patients this treatment falls short of being ideal in terms of providing the rejuvenation being sought. Many times this traditional surgical approach makes the appearance even worse.
Removing the fat bags and the skin does neither address the darkening and wrinkling or the skin or the fat atrophy that creates the tear trough, the treatment of which is just as important for rejuvenating the area. For that reason, in conjunction with removal of the fat and skin, the discoloration of the skin should be addressed as well as the fat atrophy and the wrinkles in the lower eyelids and periorbital areas too. To that end, we have added to the traditional surgery stem-cell fat grafting to the tear troughs as well as the mid-face, if necessary, plus grafting and addition of stem cells in the periorbital area and even to the forehead. With this stem cell treatment, we have observed that the color of the skin of the lower eyelids improves, as does the orbital border; i.e., the tear troughs disappear, helping as well with the wrinkling of the skin in that area. Furthermore, use of the Sciton erbium ablation laser will rejuvenate the skin, making the procedure a success. In the pictures we are presenting now, all these changes can be easily observed. The first patient presented has no makeup on. Of course no photo retouching (e.g. use of PhotoShop) has been done to the pictures, and they have been taken with the same lighting and the same camera. The results are amazing!
The pictures were taken almost 6 months after the surgery, so no fat reabsorption is expected. The results can be considered at this time permanent. Resurfacing of the skin with the Sciton laser and injection of the fat and stem cells have made all the wrinkles around the eyes and even on the forehead disappear. In addition, we assure our viewers that no Botox or any other medicine to relax the muscles has been given to this patient. We strongly believe that traditional surgery plus fat-grafting with stem cells and laser resurfacing of the lower lids and periorbital areas are paramount in order to improve the aging aspect of the mid-face.
The second patient we are presenting in this blog is a female with remarkable fat bags but also, as can be easily seen, tear troughs that show the orbital rims (i.e. the skeleton) very clearly in her mid-face. In patients like this, performing a traditional blepharoplasty will lead to some improvement in the length of the lower lids and the disappearance of the fat; however, the prominence of the tear trough will make the results less than optimal. Fat grafting was added in combination with the stem cells to the mid-face and lower lids, and the results and rejuvenation of the mid-face can easily be observed.
The third patient is a male in whom a lower blepharoplasty was performed, and the tear troughs also corrected with fat grafting enhanced with stem cells. The soft transition from the cheeks to the lower lids, as we normally have in our youth but which disappear as we age, have been restored. This picture was also taken several months after surgery, and no photo retouching has been done here either. These results will be permanent. We believe that lower blepharoplasty combined with stem cells and fat grafting to the tear troughs and/or the mid-face is the way in the 21st century for those seeking mid-face rejuvination.
