What is the best treatment for my upper and lower lids? Thermage, surgery? Thank you (Photo)

For many years, people have tried many different ways
to avoid surgery through all kinds of heating devices. There is a tremendous
amount of heating devices that improve upper eyelid hooding by trying to heat
up the skin in the forehead to tighten and raise the eyebrows. One example of a
heating device is Thermage. However, as a cosmetic oculofacial plastic surgeon,
I see a lot of patients who try all of these heating devices and they have been
disappointed.



People have always been excited about some type of new
non-surgical device that’s supposed to make surgery obsolete. And yet, hundreds
of cosmetic surgeons still perform surgery everyday because there’s a limit as
to what these devices can do. I happen to have a radio frequency device and
certainly I see the benefit of it but in a limited way for very specific
things. When I use my radio frequency device, it’s to treat very fine lines. The
application of high levels of heat to try to cause skin to contract often has a
very paradoxical effect. It is my observation that these high levels of heat
which many patients find intolerable and painful does not have any long-term
effect. Since heating involves a series of treatments, many abandon their
treatment. Many like the results of heating because the area looks fuller from
being swollen. However, the swelling goes away and the skin goes back to normal,
and in many cases, the skin gets thinner.



In our practice, we have been very busy helping people
who have gotten thermal energy treatment by trying to help them rehabilitate
their skin by using technology such as platelet-rich plasma (PRP). Platelet-rich
plasma rebuilds some of the collagen and blood supply that’s been lost. People
should understand that there is a critical amount of heat to tighten the skin
in order to get a long-term benefit. Unfortunately, heating devices are sold so
aggressively that patients end up being seduced. The results of these devices
are nothing compared to more definitive procedures.



For your upper eyelids, I would most likely recommend
an upper eyelid blepharoplasty surgery. In our practice, we do these procedures
under local anesthesia with LITE™ IV sedation and it is extremely safe. It is
not likely that you will find an alternative that would do it better than an
actual definitive surgical procedure. By having our own facility within our
practice, we made the whole surgical experience a lot easier for patients. It’s
not like going to a hospital using general anesthesia which can be a very
intimidating situation. There are also risks to general anesthesia.



As far as your lower eyelids are concerned, from my
perspective, the lower eyelids are a little bit low. Based on a physical
examination, if there’s puffiness or bags under the eyes, we would address that
surgically. If there are fine lines and wrinkles, there are options such as
fractional CO2 laser. Heating is part of the story, but the regeneration is what
we have very actively pursue to try to build the quality of the skin. We
combine fractional CO2 laser with platelet-rich plasma routinely to get this
synergy because we want to distinguish quality of skin versus quantity of skin.
We have seen patients from all over the world who have skin removed in attempt
to tighten wrinkles and invariably, the lower eyelids get pulled down and they
develop lower eyelid retraction. In our practice, we are focused more on the
qualitative improvement of the skin through the use of platelet-rich plasma
which helps stimulate the blood supply and the production of collagen. It has a
remarkable benefit in improving skin quality and it may require more than one
treatment.



I suggest that you meet with a surgeon who can give
you a more definitive evaluation, and help you understand what your desired
outcome is. Once you’ve defined that, then I think it would be clear that
heating devices are not likely to deliver the results that you want. I hope
that was helpful, I wish you the best of luck, and thank you for your question.

Your upper eyelids would benefit most from a simple skin only blepharoplasty done conservatively.  This would effectively remove the hanging skin from your upper eyelids and give them a more open and alert appearance.  The lower eyelids can be treated with fillers to the trough below the eye but it is temporary.  A permanent solution can be found in removal of the fat bulge from the lower lid or fat repositioning.  Each gives excellant results in the proper hands.  The non-surgical treatments (lasers, Thermage,etc) which were heavily marketed to tighten skin have not lived up to their promises.

When we speak of rejuvenating the eye unit, we are talking about all the aesthetically important areas that surround the eyes, namely the upper and lower lids (including the upper cheek region immediately below the lower lids); the brows; the periorbital area to the sides of the eyes; and glabella area between the eyebrows. Today, happily, each of these regions may be improved nonsurgically (i.e. without cutting, stitches or prolonged healing and downtime. In this case, the problems appear to be heaviness of the brow region and flattening of the upper inner cheek and under eye regions and the development of tear troughs.I can only make some general comments about eye unit rejuvenation goals that can be achieved nonsurgically. For example, a few microdroplets of Botox or other neuromodulator (such as Dysport or Xeomin) placed in the glabella area would help to not only lift, but reposition the slight downturning seen there. Prominent flattening of the upper inner cheek areas can be improved significantly with the use of a volumizing filler, such as Juvederm UltraPlus XC (which will likely also have the secondary benefit of improving the regions directly below the eyes. The tear troughs and hollows of the lower eyelid can be addressed with injectable fillers--my preference here being Belotero Balance, since it is unlikely to give rise to the bluish discoloration, known as the Tyndall Effect, sometimes seen with other hyaluronic acid fillers when injected superficially or within the very delicate tissues around the eyes. Consultation with a board certified aesthetic core physician with extensive experience in nonsurgical eye rejuvenation techniques would be strongly advised so that a specific treatment plan can be formulated.