Since ancient times, the appearance of the eyes has been seen as a central component of a beautiful face.  Healthy, youthful eyes are important in our perception of the face as attractive.  As we age, changes related to the enviroment (sun and smoking), genetics, gravity and time take a toll on the youthful appearance of the eye area.  Since first century Roman surgeons first described techniques of cosmetic eyelid surgery, advances have been made in both surgical and non-surgical approaches to the aging eye.

Aging of the eyes

The upper eyelids

Typical hallmarks of aging that affect the appearance of the eyes include excess skin, excess fat and laxity of the eyelids.  Excess skin of the upper eyelids may lead to an aged appearance and can even affect vision, blocking the upper visual fields.  It is important to distinguish this excess skin from eyelid ptosis, or a "lazy eyelid".  Upper eyelid ptosis or "drooping" is the result of a weakness of a muscle responsible for eyelid opening.  This can be congenital from birth, developmental with age or may be the result of trauma or medications ( a misplaced Botox injection). 

It is important to distinguish between excess, droopy skin of the upper eyelids and a droopy brow.  To differentiate between these two problems, one can manually raise the eyebrows, giving a temporary (if exaggerated) browlift.  If this corrects the problem, the issue is brow ptosis, not excess upper eyelid skin.  If this does not correct the problem, upper eyelid surgery (blepharoplasty) may be the solution.

The lower eyelids

Features of the lower eyelids that are typical of aging include the appearance of "bags" and dark circles.  Laxity of skin and a crêpe paper appearance are also often seen.  Lower eyelid "bags" are the result of pockets of fat that protrude from deep under eye, leading to bulges that yield a tired, aged appearance. 

Surgery

Upper eyelid blepharoplasty

Upper eyelid surgery, or blepharoplasty, is an outpatient procedure.  It can be performed under local anesthesia but is more often done under general anesthesia or light sedation.  The surgery is relatively straightforward, with an excision of excess skin outlined such that the suture line of closure, and therefore the scar, is placed within the upper eyelid skin fold.  Very fine sutures are placed and these are removed usually 5 days after surgery.  Most often the scar is barely visible and is hidden within the upper eyelid skin crease.  Recovery is quick and there is usually minimal discomfort.  Ointment and artificial tear solution is used for a few days and icepacks are important to minimize bruising and swelling.  Of all the facial cosmetic surgery we do, upper eyelid blepharoplasty is the least invasive with the quickest recovery and the least amount of down-time.  The result is a refreshed, more rested appearance of the eyes.

Lower eyelid blepharoplasty

Lower eyelid surgery, or blepharoplasty, is also performed as an outpatient procedure.  One of two basic incision types may be used.  The transconjunctival approach utilizes an incision inside the lower eyelid and is therefore hidden.  This technique is usually best suited for those patients that have excess fat or lower eyelid "bags" but don't need any excess skin removed.  The more standard approach used is called a subciliary (below the eyelashes) incision which is placed right underneath the lash line.  This incision heals exceptionally well with a scar that is usually imperceptible.  Once the incision is made excess fat that is protruding and causing "bags" is removed.  Any excess skin of the lower eyelids is then removed and tiny sutures are placed to close the skin.  These stitches are removed 5 days after surgery.

Nonsurgical treatments

A variety of non-surgical treatments can be used to make cosmetic improvements in the eye area.  Botox® is particularly effective for "crow's feet" on the side of the eye and this is essentially the only thing that works well for those lines.  Dermal fillers such as Restylane® are used to fill in an under-eye hollow that can cause people to look tired and gaunt.  Lasers are used for treatment of crêpe paper skin and fine lines of the lower eyelid.  Skin care products such as creams and gels have somewhat limited results but are helpful in hydrating the skin and temporarily improving the appearance of fine lines.

Last year we saw a number of advances in aesthetic medicine- novel dermal fillers, a new alternative to Botox called Dysport, new lasers and other devices and expanded uses for existing products like Sculptra.  Of all the new products hitting the market over the past year, Latisse® has, in my opinion, been the most impressive.  The first FDA-approved treatment for eyelashes, Latisse® is highly effective in lengthening, thickening and darkening a patient’s natural lashes. 

Some background on Latisse®

The active ingredient in Latisse® was first FDA approved in 2001 as an eyedrop for treatment of glaucoma.  The drug was called Lumigan®.  One side effect seen in patients using the eyedrops was eyelash growth.  This is similar to the side effect of scalp hair groth in men treated with the prostate drug Proscar®.  In that case, the manufacturers rebranded the drug at a lower strength and marketed it as Propecia®.  In the case of Lumigan, the concentration has remained the same but the application is directly on the lash line instead of eyedrops placed in the eye.

A few years ago, cosmetic company Athena promoted a product called RevitaLash and Jan Marini produced a product called Age Intervention  Eyelash conditioner.  Both of these products had Bimatoprost or something like it and they were pulled from the market after  the FDA determined they were drugs that should be approved and regulated.  Botox® maker Allergan had undertaken the appropriate studies and received FDA approval for Latisse in December, 2008.

How Latisse® works

The active ingredient of Latisse® is Bimatoprost, a prostaglandin analog.  It binds to prostaglandin receptors on hair follicles and increases the number and length of time hairs are in the active growth phase.  Latisse® is a liquid that is applied to the eyelash margin on the upper eyelids using sterile applicators provided with the product.  In clinical tests, Latisse was seen to have a gradual effect with maximum improvement in eyelash growth seen at 16 weeks.  In my experience, patients see a significant improvement within 6 to 8 weeks and by 12 or 16 weeks, the effect is dramatic.  Discontinuation of Latisse® results in a gradual return to the pre-treatment state within a couple of months. 

Possible side effects of Latisse®

Although uncommon, possible side effects include darkening of the eyelid skin and even darkening of the iris (the colored part of the eye).  Darkening of the iris is rare and is most commonly seen when drops are placed in the eye in the treatment of glaucoma.  The darkening of eyelid skin is usually reversible with discontinuation of Latisse® but the rare cases of iris discoloration can be permanent.  It’s important to use Latisse® as directed, with application only on the upper eyelids.  One recent patient of mine was using it on her lower eyelashes and it worked too well- a small amount of the liquid rolled down her face so that she had what she called “eyebrows” on her cheeks that she had to shave!  Another possible side effect that is more common with Latisse® is eye sensitivity or irritation.   

Patient satisfaction with Latisse®

Of all the recent advances in aesthetic medicine, I have seen the perhaps the highest patient satisfaction rate with Latisse® .  For those women who have concerns about thin, short or fine lashes, Latisse® is a great (and only FDA-approved) option to grow their own lashes.

Botox treatments typically take effect within 5 to 7 days and last on average 3 months. A typical treatment area varies in the amount used from 12 to 30 units per area. The average amount used, for example, in the glabella (that area between the eyebrows, or the "11 lines") in my practice is 24 units; sometimes less, sometimes more. For the forehead this amount ranges from 12 to 20 units (the forehead is a larger area but the muscle is a weaker one, so it requires less) and for crow's feet treatment I usually use 12 units per side.

Dysport^®
Dysport is the newest botulinum toxin product on the market and it's the first product to compete with Botox in the United States. It has been used for years in Europe and in South America with good results. To assure safety, FDA approval in the U.S. took several years but it was finally approved in April 2009. It is marketed and sold by Medicis, the makers of Restylane^®.

The active ingredient in Dysport, botulinum toxin-A, is identical to Botox. The difference is in the "complexing proteins" surrounding this active molecule. Dysport has different proteins and fewer proteins attached to the botulinum toxin-A molecule. This is said to account for its quicker onset of action and possible longer duration of action compared to Botox. It also may make it a good choice for long-time Botox patients who have developed antibodies and for whom Botox is no longer effective (very uncommon in my experience).

Since coming to market in April of last year, I have treated well over 300 patients, and I've been impressed with the results. My experience has been that Dysport does begin working quicker than Botox. On average, patients see a result from Dysport within 48 to 72 hours and sometimes as quickly as one day. Like Botox, results continue to improve after the initial onset of action for as long as 2 weeks.  In terms of the duration of effect, the Dysport labeling indicates 3 to 4 months and I have found most patients have results lasting about 4 months. This represents maybe a few weeks of extra duration compared to Botox. Since we have been using Dysport in the U.S. for less than a year, I am not convinced that Dysport lasts significantly longer than Botox.

Units and Pricing
For those who are familiar with Botox dosing, it is important to know that Dysport units are different than Botox units. In my practice, I use an approximate ratio of 2.5 units of Dysport:1 unit of Botox but there is no standard conversion or ratio that is agreed upon amongst practitioners. Dysport units are simply different than Botox units and therefore it's important to find a good injector who is experienced using both products. Like Botox, each Dysport treatment should be tailored to a patient's goals, to the specific area being treated, and to the individual's unique anatomy. The number of units used per area really means nothing in terms of the treatment itself or in terms of price. With the reconstitution (mixing) method I use, the volume I use for injections of Dysport is identical to that of Botox. The number of needle sticks (I use a tiny insulin-type needle) is the same. The per-unit price is such that the cost of a treatment area with Dysport is the same as the cost of Botox.

So Which is Better?
From my perspective, Dysport and Botox are equally effective in treating lines and wrinkles of the forehead, the brows and crow's feet. Both have the same excellent safety records. In my opinion, Dysport has a slight but definite advantage in that it works quicker and may last slightly longer.

"Beauty is in the eye of the beholder."

It has long been said that beauty is in the eye of the beholder and thought that beauty varies by race, culture or era.  The evidence, however, shows that our perception of physical beauty is hard wired into our brain and based on how closely one's features reflect phi in their proportions.  Take another look at beauty through the eyes of medical science.

A template for human beauty is found in phi and the pentagon

The symbol phi has been used to refer to the number 1.618- the golden proportion first illustrated by Leonardo DaVinci.  It is a number or ratio that is consistently found in nature, art. architecture and the human body.  Also called the "Divine Proportion" when referring to human anatomy, it has applications when considering the aesthetic ideal of the face. 

The number phi has been studied by Dr. Stephen Marquardt for years in his practice of oral and maxillofacial surgery.   Dr. Marquardt performed cross-cultural surveys on beauty and found that all groups had the same perceptions of facial beauty.  He also analyzed the human face from ancient times to the modern day.  Through his research, he discovered that beauty is not only related to phi, but can be defined for both genders and for all races, cultures and eras with the beauty mask which he developed and patented.  This mask uses the pentagon and decagon as its foundation, which embody phi in all their dimensions.  For more information and other examples, see his site at Marquardt Beauty Analysis.

1350 B.C. Egypt	500 B.C. Greece	164 A.D. Rome	1794 A.D.

Asian	Black	Caucasian

The Marquardt Beauty Mask

Even with a perfectly proportioned face though, there are endless variations in coloring and the shapes of each facial feature (eyes, eyebrows, lips, nose, etc.) that give rise to the distinctive appearance of each race and provide for endless variations in beauty that are as unique as each individual.

The human face communicates an incredible array of emotions which are an integral element of one's total beauty.  The human face conforms most closely to phi proportions when we smile.  You'll be perceived as more beautiful with a warm smile than with a cold-hearted look of anger, arrogance or contempt.

Note:  The Marquardt Beauty Mask illustrations above are copyright 2001 by Dr. Stephen Marquardt at Marquardt Beauty Analysis and are used by permission.

The ideal aesthetic of the face is related to phi

When considering aethetic improvements to the face, one must take into consideration several things: obviously the aesthetic goals of the individual, their age, skin and soft tissue characteristics and underlying bone structure all figure into the equation.  The proportion phi=1.618 can also be used as a guideline when considering the aesthetic ideal.

Soft tissue augmentation and dermal fillers

For years, various demal fillers have been used in plastic surgery years to fill in lines, wrinkles and creases of the face to make cosmetic improvements and ameliorate signs of aging.  In recent years, new products have come to market for volumizing and to augment areas of the face.  Radiesse, an injectable gel of a material called hydroxyappetite is used in my practice primarily for augmentation of the cheeks.  Artefill is a long-lasting injectable gel of poly methyl methacrylate that can also be used for facial soft tissue augmentation.  More recently Sculptra Aesthetic  has received FDA approval for cosmetic use.  Formulated from poly-L-lactic acid, this filler product was originally approved for the treatment of HIV-associated facial wasting syndrome, seen in patients treated with anti-retroviral drugs.  Sculptra effectively replaces lost facial volume in such patients and now the product is approved for treating facial volume loss associated with aging.  The treatment is different than other fillers in that multiple treatments are performed and the results are gradual over time.  Results can be impressive, with significant volume being replaced to restore the ideal proportions of the face consistent with the aesthetic ideal of youth.   

  

If you need further information, please contact us.

Luxury

Combining the knowledge and expertise of a plastic surgeon with the luxury of a top day spa, Physician’s Center for Beauty is dedicated to making you feel comfortable during your visit.

With our relaxed, soothing atmosphere and our friendly staff, you can put your mind at ease while being pampered in luxury.

Artistry

Plastic surgeon Dr. Sean Maguire is skilled in the art of Facial Sculpting- a technique of non-surgical facial rejuvenation and enhancement perfected through years of training and his experience treating thousands of patients. With his attention to detail and a keen eye for aesthetics, Doctor Maguire achieves amazing results with non-surgical facial sculpting. As a leader in the technique of the Liquid Facelift, he can obtain natural-appearing results with little or no down time.

Science

Using pharmaceutical-grade skin care products with proven clinical results, our skin care specialists are skilled in the science of healthy skin. Utilizing the Visia® skin analysis system, we educate our clients about their skin condition, affected by exposure to sun and environmental toxins and the general aging process. A skin care regimen specifically tailored to your needs is designed and follow-up is provided to assure healthy, beautiful and radiant skin.

Technology

With the latest in state-of-the art aesthetic technology, Physician’s Center for Beauty performs FDA approved treatments under the direct supervision of a doctor. Our Laser Center features the most advanced laser and light devices available today, administered by trained laser technicians and Dr. Sean Maguire, Kentucky’s only plastic surgeon with laser fellowship training.

During a Pearl treatment, the top layer of the skin is treated with pulses of light. A portion of the epidermis (skin surface) is gently removed and a natural protective dressing is formed on the skin’s surface. Most patients feel a series of brief pinches during the treatments. After 3-4 days, the protective dressing peels off revealing new, healthy, vibrant skin underneath.

Learn more about Pearl Laser Treatment here.

BOTOX^® Cosmetic is the only treatment approved by the FDA for the temporary relief of moderate to severe frown lines between the brows in people 18 to 65 years of age. With one simple 10-minute treatment, results can be seen within a couple of days and can last for up to 4 months. Individual results may vary.

Learn more about Botox here.

DYSPORT™ is a prescription medicine that is injected into muscles and used

• to treat the abnormal head position and neck pain that happens with cervical dystonia (CD) in adults.
• to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults younger than 65 years of age for a short period of time (temporary).

CD is caused by muscle spasms in the neck. These spasms cause abnormal position of the head and often neck pain. After DYSPORT™ is injected into muscles, those muscles are weakened for up to 12 to 16 weeks or longer. This may help lessen your symptoms.

Frown lines (wrinkles) happen because the muscles that control facial expression are used often (muscle tightening over and over). After DYSPORT™ is injected into the muscles that control facial expression, the medicine stops the tightening of these muscles for up to 4 months.

Learn more about Dysport here.

                                                                                                                                        
DOT Therapy (Dermal Optical Thermolysis) is a new and exciting way of reversing the appearance of aged or sun-damaged skin, smoothing wrinkles, and reducing the appearance of acne or other scars. Because DOT Therapy delivers the desired outcome with minimal downtime, it is rapidly replacing traditional laser skin resurfacing as the treatment of choice for mild to moderate signs of photo damage.

Learn more about Dot Laser Therapy here.