72 MARCH 2016
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Surgical Aesthetics
Trichloroacetic acid (TCA) peels can help tighten and rejuvenate the lower lid.
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GETTY
IMAGES
SURGICAL
AESTHETICS
IN THE EYE OF THE BEHOLDER
and the cheek. This can be treated nonsurgically with fi llers
in some patients; others will require surgery.
"In the upper lid, defl ation occurs along the orbital rim or
the brow where the eye socket meets the eyebrow," Dr.
Stevens explains. "You see the soft tissue hollowing out and
caving in, and the skin starts to hang, particularly along the
lateral third of the upper lid orbital rim. This can be treated
nonsurgically with volume replacement or injectables."
Dr. Stevens prefers to use fat, often in conjunction with
surgical procedures, to address upper eyelid defl ation. For
the lower lid, he also uses a resurfacing laser, ranging in
density from least invasive to more invasive depending on
the patient.
The fi nal D is descent, which causes fat to bulge out
on the lower lid and creates excess skin on the upper lid.
"These are more surgical concerns that are not as readily
corrected with nonsurgical approaches," says Dr. Alessi.
Dr. Rizk reserves surgical treatments for situations where
there is advanced skin laxity, herniated orbital fat pads, muscle
laxity and scleral show. Mild lines and wrinkles can be cor-
rected temporarily with Botox, he says.
"Restylane injections may be useful for restoring the tear
trough and hollows under the eyes that can cause a darkened
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