Eye Rejuvenation

Aging of the Eyes
Your eyes are the first thing people see when they look at your face; an immediate impression is formed about your age, level of energy and fatigue. The eyes are also the first part of the face to show the signs of aging. Youthful eyes sparkle and look refreshed and alive, but aging causes a combination of changes that result in excess skin of the upper and lower eyelids, puffiness or bags of the lower eyelid, sagging of the corners of the eyebrows that causes hooding in the outer corners of the eyes and loss of volume around the eyes, temples and cheeks. As the skin thins in this region, fine lines and wrinkles start to form, further aging your appearance. This sagging, coupled with deflation, results in a hollow, sallow and fatigued look consistent with an aged appearance. These changes typically start in the mid–to–late 30s and progress rapidly throughout the 40s and 50s.

It is important to note that when people look at your eyes, they don’t just see the upper eyelids or lower eyelids, they see the entire region around your eyes. This includes the skin, the hollows and dark circles beneath the eyes and the sagging eyebrows. Gone are those sparkling windows to the soul, replaced by fatigued, morose and shaded eyes.

eye rejuvenation patient

Eye Rejuvenation Patient: Upper eyelid blepharoplasty, lower eyelid blepharoplasty with lower eyelid skin pinch, and fat transfer

before and after eye rejuvenation

Eye Rejuvenation Patient: Upper eyelid blepharoplasty, lower eyelid skin pinch, and fat transfer

before and after photo

Eye Rejuvenation Patient: Upper eyelid blepharoplasty, lower eyelid skin pinch, and fat transfer

before and after eye rejuvenation procedure

Eye Rejuvenation Patient: Upper eyelid blepharoplasty, lower eyelid blepharoplasty with lower eyelid skin pinch, and fat transfer

Eye Rejuvenation

Eye Rejuvenation may be one of the most high–impact methods of facial rejuvenation. Traditional approaches focus on blepharoplasty, or eyelid surgery in which skin, muscle and fat are removed in order to sculpt the eyes. In reality, the results of this procedure often make eyes look older and simply different, not better. This misses the entire goal of eyelid surgery, which is to make the eyes look refreshed and revitalized.

Our preferred method is to take a comprehensive and holistic approach to the treatment of the various changes affecting this region.

The first step is a thorough assessment of the periorbital region. Aging of the eyes results from a combination of changes to different components around them. Careful evaluation of these changes is the first step toward a true and meaningful eye rejuvenation that will leave the eyes looking bright, healthy and fresh—and natural.

The Three Components of Periorbital Aging:

  1. Skin Lines and wrinkles, thinning and loss of elasticity.
  2. Volume Loss of fat, presence of hollows and shadows.
  3. Sagging Excess skin of the upper and lower eyelids, presence of bags underneath the eyes and hooding of the outer corners of the eyes as a result of lateral eyebrow sagging.

Treating Periorbital Aging:

  1. Skin The skin around the eyes can become wrinkled from repeated movement of the muscles between the eyes (glabella) and around the corners of the eyes (crows feet). An assessment for the presence of folds between the eyebrows and lines beneath and around the eyes is performed.
  2. Volume loss As we age, we lose fat in the region around our eyes, temples and cheeks. This progression has little to do with your body weight; rather, the fat stores in the upper cheek and area around the eyes are genetically predisposed to loss with age. Specifically the periorbital fat loss affects the temples, upper brows, below the brows, below the eyes and upper cheeks.
    This results in dark hollows under the eyes, a deflated sunken look in the cheeks and a skeletonized bony look in the temples and upper eyelids.
  3. Sagging The upper and lower eyelids begin to accumulate excess skin, which leaves the eyes looking heavy. In some cases, the lower eyelids accumulate fullness resulting from fat pads pushing outward “bags.” The outer brow (lateral brow) also begins to sag, causing further hooding and upper eyelid heaviness.

Our Unique Treatment Approach

Comprehensive Eye Rejuvenation
When these changes occur to each of the periorbital components, a specific treatment is assigned to each affected region noted above. Following a comprehensive assessment of the aging–related changes around the eyes, a much more sophisticated treatment plan can be prepared. The plan commonly involves a variety of non–surgical and conservative surgical modalities that, when combined, truly rejuvenate the eyes with minimal risk and downtime. This leaves the eyes looking revitalized and rejuvenated without changing their shape or function.

  • Skin Botox is used to decrease the line between the eyebrows (the 11’s) and the lines on the outer portion of the eyes (crow’s feet). The thinning, crepey skin can be resurfaced with either a Jessner’s/35% TCA chemical peel or Er:Yag laser resurfacing.
  • Volume Loss When we lose the fat layer along the lower eyelid region and upper cheek, the eyes begin to look hollow, which gives the impression that we’re fatigued and aged. An important and highly–emphasized part of our eye rejuvenation philosophy is volume restoration with Fat Transfer.
  • Fat Transfer This is a treatment that complements our surgical procedures and is done with essentially every rejuvenation case (approximately 350 cases per year). It is used to restore the lost volume surrounding the eyes. Commonly filled areas are the temples, upper eyelid and eyebrows, along the lower orbital rim, tear troughs and upper cheeks. This results in long–lasting and natural volume restoration.
  • Adding volume is the most effective and important way to rejuvenate the eyes.Without it, the skin and sagging may look better, but the eyes will never have that refreshed and youthful look.
  • Sagging When excess skin is present, a conservative surgical procedure is required to remove it. The following procedures are used to treat the specific issues.
    1. Upper Eyelid Blepharoplasty: The removal of excess upper eyelid skin.
    2. Lower Eyelid Blepharoplasty: The removal of the fat pad (“bags”) and loose skin of the lower eyelid.
    3. Lower Eyelid Skin Pinch: The removal of loose lower eyelid skin only. This is done when there are no fat pads to remove, but only loose lower eyelid skin.
    4. Lateral Brow Lift: Used to lift the outer brow, diminishing the hooding and heaviness of the upper eyelid region.

While men and women enjoy looking years younger and benefit from these procedures equally, the techniques are different for each sex. Dr. Karam’s experience and expertise allow him to successfully handle the nuances related to different ethnicities and sexes and to create a natural rejuvenation of the entire region.

Is Eye Rejuvenation Right for Me?

Our comprehensive Eye Rejuvenation program can help alleviate many problem areas associated with aging. Eye Rejuvenation is for those who want to:

  • Eliminate that aged, tired look
  • Look fresh and energetic
  • Improve dark circles
  • Remove bags under the eyes
  • Restore the plumpness of youth
  • Return your skin and brows to their original position
  • Recover the self–confidence of your younger years

Advantages of Comprehensive Eye Rejuvenation

  • Total rejuvenation of the entire region around the eyes
  • Balance and harmony of the eyes
  • Consistency and reliability
  • Low complication rate
  • Long–lasting results (10+ years)
  • No change in eye shape or change in facial features
  • Performed under local anesthesia with IV sedation; no need for general anesthesia
  • Two week downtime
  • Ideal balance between excellent and natural results, low risk and brief recovery

What To Expect
Procedures and Anesthesia

Perhaps one of the biggest advantages from a safety standpoint is that these procedures can be performed under local anesthesia with IV sedation. With this technique, patients are comfortable, moderately sedated and without any discomfort. Most patients choose this method to avoid any of the risks associated with general anesthesia. For those patients who do prefer general anesthesia, our facility is fully–equipped for general anesthesia.

Procedures are performed in our accredited and certified (JCAHO and Medicare) surgical center, Carmel Valley Surgical Center, located within the suite. The center offers the highest level of safety and state regulations for outpatient surgery. Highly–trained and experienced surgical techs, medical assistants, nurses and a Board Certified Anesthesiologist all work together to create the safest and most comfortable experience possible. Carmel Valley Surgical Center hosts two state–of–the–art surgical suites and a recovery center. The rooms are equipped with only the best equipment and instruments, and the center also has a separate entrance and exit from the main office, which allows our patients to undergo procedures in privacy. Your comfort is always our priority during these surgical procedures.

Post–Procedure Care

Following surgery, ointment is applied to the incisions. In cases where a Lateral Brow Lift is performed, a gauze dressing is applied and wrapped around the head for one night. Patients return to the comfort of their home or hotel room, then come back for an in–office check the following day where the dressings are removed and the face is examined. A cool compress is used to reduce swelling for the first two days following surgery. Lubricating drops are used during the day and ointment is used at night to help keep the eyes moist and protected from drying. Antibiotic ointment is applied to the incisions for one week. At one week, sutures are removed in the office. At this point, swelling is starting to resolve rapidly. Follow–up appointments are made at one month, three months, six months and one year to monitor healing and make sure all questions are answered.


Recovery is primarily related to swelling. Bruising is not commonly seen in our patients, although it is a possibility. The typical recovery takes between 10–14 days. We recommend planning two weeks off of work or social engagements to allow sufficient time to heal. Although healing is not completely finished by two weeks, most patients are sufficiently healed and can return to work and other social occasions. Minor swelling continues to improve steadily for up to one year following the procedure. Exercise is resumed between three to four weeks following surgery, depending on the nature of the activity and the degree of swelling involved.

What to Expect: Results

There are a variety of positive results you can expect from you Eye Rejuvenation, including:

  • Youthful and natural–looking appearance
  • Eliminates hooding and heaviness of eyelids
  • Full and healthy upper lid complex (no longer skeletonized, harsh or bony)
  • Eradicates under–eye bags
  • Long–lasting outcomes that look like your genuine, younger self
  • Restores self–confidence

Why Choose Dr. Karam for your Eye Rejuvenation Procedure

An average Board Certified Plastic Surgeon preforms approximately 20 eyelid and brow procedures annually. Dr. Karam, on the other hand, preforms over 350 every year. Extensive experience translates to more natural results, more consistency and less variability, plus a distinct knowledge of different ethnicities and facial types and how to change the techniques to best suit the particular facial structure. Dr. Karam’s careful and intentional approach ensures that no one changes their identity, but simply looks refreshed and youthful.

Dr. Karam’s comprehensive approach, which involves combining these procedures with others, results in synergistic effects. The entire face looks naturally and vibrantly youthful, rather than hosting a single, unnatural element. In his text book, Rejuvenation of the Aging Face, Dr. Karam describes his approach to facial rejuvenation and eye rejuvenation in order to teach the ingenious techniques to other surgeons and colleagues. Dr. Karam’s expertise in the subject has also prompted him to write a number of book chapters and scientific articles on facial plastic surgery topics, including upper and lower eyelid blepharoplasty, fat transfer and rejuvenation of ethnic–specific (for example, Asian) groups.

And perhaps most importantly, Dr. Karam’s caring demeanor, excellent patient communication skills and responsive and knowledgeable staff ensure you’re always comfortable and informed. It’s these particular attributes that have earned Dr. Karam the trust to perform these procedures on his medical colleagues and their families.

Planning Your Consultation

During the consultation, your expectations will be discussed and a personalized treatment plan will be proposed after careful examination and discussion of your goals. The basic criteria for timing of this procedure is dependent on two factors: first, whether there is enough sagging to justify the procedure, and the patient’s readiness to move forward. The average patient defines the changes seen in their 40s as a point where comprehensive eye rejuvenation would make a positive difference. In general, the earlier the better. The advantages of performing the surgery sooner are that the changes are less dramatic and more subtle, and the results last longer. More and more patients are utilizing these procedures as a way to maintain their appearance and prevent aging.

To discuss arranging your own consultation, please call 858–259–3223 or send an email inquiry.

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