MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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"THE ENEMY OF GOOD IS PERFECTION. MINOR REVISIONS ARE ALWAYS BETTER THAN MAJOR RECONSTRUCTIONS." "Deterioration is typically where things are declining on the surface—skin quality, skin elasticity, fi ne lines, brown spots, red spots and wrinkles," he says. "All of this is nonsurgical, unless you consider laser surgery, which can correct some of these concerns." He uses neurotoxins for fi ne lines and wrinkles, particu- larly in the crow 's feet area. "Sometimes you can get a little bit of a lift of the orbit or the brow by putting Botox in the right place strategically on the upper lid," says Dr. Stevens. Dr. Alessi uses neurotoxins for minor brow lifting by injecting into the eyebrow depressors. "Crow's feet can be reduced with Botox injected into the lateral orbicularis oculi," he says. "A small amount of Botox in the mid-lower lid can give the eye a more rounded and youthful appear- ance. Fillers such as a thinner hyaluronic acid product or fat are excellent ways to treat the tear trough." He prefers fractionated CO 2 for decreasing fi ner periorbital lines, and Solta Medical's Thermage radiofrequency device to provide noninvasive lifting around the eyes. Defl ation occurs in the face and the orbit. Where you often see defl ation around the eye, according to Dr. Stevens, is on the upper lid and on the lower lid. On the lower lid, it manifests as a hollowing out at the border of the lower lid David Alessi, MD, founder and medical director of the Alessi Institute for Facial Plastic Surgery in Beverly Hills, California, regularly hears complaints from both sexes about crow's feet, glabellar wrinkles and tear trough sulci. But since men age differently than women—and tend to come in for consults at a later age—they are more likely to also have brow ptosis and festoons (very large, saggy lower eyelid bags). "Women will come in earlier in the aging process when noninvasive procedures are more likely to be benefi cial," he says. "They are usually more concerned about fi ner facial lines and are more likely to ask for procedures, such as laser resurfacing." Sam Rizk, MD, a facial plastic surgeon practicing in New York City, agrees. "Men are focused on upper lid laxity and puffi ness—or bags—on the lower lid area. Women complain about losing the sharp crease of their upper lids (where they apply makeup), crow's feet, wrinkles and sagging skin." Evaluating the Three D's Whether the patient is male or female, Leslie Howard Stevens, MD, of the Lasky Clinic in Beverly Hills, California, evaluates periorbital concerns using the Three D's: deterioration, defl a- tion and descent. SIGNS OF AGING IN THE PERIORBITAL AREA are among the fi rst concerns that bring patients to cosmetic practices. Whether they are bothered by crow's feet, hooding of the eyelids, or undereye bags and discoloration, patients know they can fi nd relief through a variety of noninvasive and surgical means. But this wide range of treatment options requires physicians to look closely, not only at the patient's anatomy, but also their gender, budget and desired outcomes. surgicalaestheticsmagazine.com | MARCH 2016 71 © GETTY IMAGES