•  
• HOME
• ABOUT
  • mission
  • philosophy
  • dr karam
  • how to choose your surgeon
  • facilities
  • staff
  • publication
• SURGICAL
  • rhinoplasty / nose surgery
  • facial rejuvenation
  • facelift surgery
  • fat transfer
  • rejuvenation of the eyes
  • otoplasty / ear reshaping
• NON-SURGICAL
  • skin rejuvenation
  • volume restoration
  • injectables
  • latisse
  • non-surgical eye rejuvenation
  • botox®
  • non-surgical rhinoplasty
  • natural lip augmentation
• PHOTOS
• TESTIMONIALS
• NEWS
  • in the media
  • press kit
  • articles
• CONTACT
• PATIENT FORUM
  • patient intake forms
  • post treatment instructions
  • faq
  • financing
  • out of town patients
  • blog

Since people look at our eyes during face to face conversation, refreshing this region has important social, professional, and personal implications.

I view the lower eyelid region as the space below the lower eyelash to the upper cheek. This is one of the most important and complex areas of facial aging because the signs of aging start early and make a major impact on how other’s perceive us. They create an impression fatigue, lack of energy, and lack of sleep. If you are well-rested and have energy, most individuals don’t want to give off those impressions.

1. The presence of a smooth transition between the lower eyelid and upper cheek
2. A short lid-cheek junction (see figure)
3. Lack of fine lines and wrinkles
4. Lack of hollows and concavities

During youth, the inferior orbital rim (the bone of lower eye socket) is covered with a layer of fat and looks smooth. You can’t see the outline of the bone. Instead you see a smooth transition between the lower lid and cheeks. Starting in our thirties, the volume underneath our eyes begins to diminish as the fat diminishes as a result of genetic and age-related changes. Specifically, there is a fat pad underneath the muscle around the eye called the sub obicularis oculi fat pad (SOOF). With age this fat begins to diminish and gives way to skeletonization of the inferior orbital bony rim. This change elongates the lid-cheek junction, which makes the eyes look drawn and sunken. This loss of volume is also responsible for the hollow and dark appearance of the lower eyelids. Unfortunately, this process affects everyone.

This term as become popular. It is region between our eye and nose. The valley that is formed when the volume of the eye is diminished is called the tear trough (see Figure). As the tear trough gets deeper, the eyes look more hollowed and a groove is formed which cast a dark shadow. This tear trough deformity is possibly one of the most important contributing factors to the aged lower eyelid. Treatment of this region is essential when creating a healthy, well-rested, and youthful look. Treatment of a tear trough deformity typically centers around volume augmentation. Fillers, fat transfer, and fat repositioning are the treatments used to restore the lower eyelid contour.

In some cases, the changes mentioned above, result in the "unmasking" of lower eyelid bags. Bags are thought to be due to excess fat that is pushing out toward the skin. Many times however, these may not be true excess fat but instead be related to the loss of volume around a normal eyelid contour. In other words, the deeper the hollows around the natural lower lid, the more prominent the "bags" will appear. In other cases, there is truly an excess of fat which would require direct treatment with a lower eyelid blepharoplasty. This can be performed as a transcutaneous lower eyelid blepharoplasty or as a transcutaneous lower eyelid blepharoplasty. The decision will be based on the individuals specific anatomy.

Just like the upper eyelids, the lower eyelids are prone to excessive eyelid skin formation. In these cases, the lower eyelid skin needs to be removed to create a tighter and smoother lower lid contour. Treating this region would require a skin-only lower eyelid blepharoplasty.

Successful and natural rejuvenation of this region requires an accurate assessment of the underlying problem and contributing factors. Like any other medical treatment it starts with a diagnosis.

In general, there has been a major paradigm shift in the treatment of the lower eyelid region in the last five years. Our modern approach centers around volume and conservative surgical excision. In many cases, volume augmentation is all that is needed to create a smooth youthful lower eyelid complex. Other times, we need to remove some skin or fat in order to achieve the desired effect. The guiding concept is to restore a natural look, never to change the shape or position of the eyelids.

Restylane for filling the Tear Trough Deformity,

Fat Transfer to create a youthful lower eyelid and cheek complex,

Transconjunctival Blepharoplasty to remove the excess fat of the lower eyelids,

Skin-only Lower Lid Blepharoplasty to tighten the excess lower lid skin.

35% TCA to remove fine lines and wrinkles.

Contact Dr. Karam