The “Eyes” of March

Our eyes are one of the first features people notice when meeting us. Eyes are a prominent facial feature.  It is the surrounding skin, muscle, fat, and hair rather than the eyes themselves that convey emotion. They really are the windows to our soul. What do your eyes say about you? Are you tired or well-rested? Are you happy or sad? They even can reflect our overall health status. Prominent, bulbous eyes can be indicative of systemic disease. Many factors impact the appearance of our eyes and surrounding tissue. Of course, as we age the skin around the eyes becomes more lax and can sag. The tissue of the upper eyelids begins to sag and can obstruct our field of vision and make us look tired and angry. The skin becomes even thinner and dark circles appear. Stress and fatigue produce the bags under our eyes. Age, loss of moisture to the skin, smoking, sun exposure and hereditary factors all contribute to wrinkles, deep lines and puffiness around the eyes. The aging process can cause unwanted changes in expression, causing us to look fatigued and older than we really are.

What can be done to refresh and brighten these tired-looking eyes? I am happy to say today we have many options to give us beautiful, youthful, and refreshed eyes. Many of these treatments are non-surgical with virtually no downtime.

Wrinkles/Crow’s Feet

Periorbital Laser Skin Resurfacing

Over the years, technology has evolved to help patients look and feel better about their damaged skin by improving the skin texture, wrinkles, acne scars, and imperfections.

Dr. George Lee utilizes the advanced Starlux 500 system from Palomar; offering a less invasive alternative replacing traditional, very painful CO2 lasers fraught with potential postoperative sequelae. This includes prolonged recovery, redness, scarring, and possible lines of demarcation of treated and untreated skin. With advances in fractionated laser technology, one will get all of the benefits of a CO2 laser, but with minimal down time. Fractionated laser treatment can be ablative and non-ablative.

“Fractional” laser technology delivers light in patterns of small microbeams, basically “pixels” of laser energy similar to the pixels of the computer screen you use. The very narrow beams heat the dermis in tiny columns, stimulating collagen remodeling as well as affecting the epidermis. Because only part of the skin is treated, the outer layer is not vaporized or only partially vaporized and the skin is not left raw which greatly reduces down time as compared to traditional CO2 lasers.

The benefits of fractional laser treatments become more evident over weeks to months after treatment. Typically, for the ablative skin resurfacing one treatment is only required, but a series of at least four to six treatment sessions is necessary for non-ablative skin resurfacing.

Botox Cosmetic

Facial expressions are created by the use of facial muscles. With repetitive movement of these muscles, wrinkles, called dynamic wrinkles, can appear. Around the eyes these wrinkles are more commonly referred to as “crow’s feet”. Botox Cosmetic is a purified protein produced the Botulinum bacteria. When used in small doses prepared for professional use, it can treat these dynamic wrinkles. It works by weakening the muscles responsible for facial expression, without detracting from these expressions, therefore treating the associated wrinkles. Botox Cosmetic is a temporary treatment. Follow up treatments are recommended every 4-6 months.

Sagging/Drooping Eyelids and Eyebrows


Our eyelids begin to “sag” as we age. This is because we blink 10,000 times over the course of a day and the skin and muscles of the upper eyelid stretch with each blink. Over time the elastic fibers, which cause the skin to recoil, stretch to the point they are unable to return to their normal position. The skin then begins to bulge outward and can hang over our lid or lie on our eyelashes. This can lead to sight problems as the excess skin obscures our field of vision. The “bags” under our eyes develop as we age. Gravity contributes to this as well as weakening of a protective membrane surrounding the eye. This membrane serves to hold the fatty tissue around the eye; however, if it weakens it can allow the fatty tissue to protrude downward, creating the look of “bags”.

Blepharoplasty is a relatively simple procedure that removes excess skin, muscle, and fatty tissue from the upper and lower eyelids. A small incision is made in the upper and/or lower eyelids to remove the excess tissue. The incision is closed with sutures and because the skin of the eyelids heal extremely well the scars are typically not noticeable. Blepharoplasty is routinely performed on an outpatient basis with patients returning to normal activity within a week.

Brow Lift

The eyebrows are important features to our face that conveys emotion. By framing the eye, they enhance the expression of our eyes. Eyebrows that sag are an early sign of aging and if the brow overshadows the eyes it can make us appear tired, sad, or even angry. Heavy eyebrows can be a result of the aging process over time or even hereditary. The drooping brow, like drooping eyelids, can affect our vision. A high, arched eyebrow conveys a rested, more alert, and youthful appearance.

A brow lift is a procedure that lifts and smooths the eyebrow and the entire forehead area. A variety of techniques can be utilized based on the nature of the problem, gender, degree of correction, age, and even how we wear our hair. Surgical options consist of an indirect brow lift, coronal lift, direct eyebrow lift, mid-forehead lift, or endoscopic brow lift. Dr. Lee will you help make the decision on the best approach after a personal consultation. Most patients are able to resume their normal routine approximately two weeks following the procedure. As with the blepharoplasty, the brow lift can be performed on an outpatient basis and can also be combined with a blepharoplasty.



Blepharoplasty and Brow Lift – Before           Blepharoplasty and Brow Lift – After


Blepharoplasty and Brow Lift – Before           Blepharoplasty and Brow Lift – After


Brow Lift – Before                                               Brow Lift – After


Periorbital Resurfacing – Before                    Periorbital Resurfacing – After

Provided courtesy of David Kent, MD and reprinted with permission of Palomar Medical Technologies, Inc.