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The Eyes Have It – Aging and restoration of the periorbital complex


“The eyes are the windows to the soul,” since our eyes give clues to our moods and emotions.  Studies find that we focus most of our attention on the eyes during personal interactions, so changes associated with aging are often first noticed around the eyes.  

A youthful, healthy eye has very smooth curves which reflect light and avoid unnatural shadows.  The eyelids appear short and have a natural transition into the cheek and brow.  There is a full brow, which in a female, peaks above the bony orbital rim laterally before descending, giving a characteristic feminine arch.

As we age, there are changes in the bone and soft tissues around the eyes.  The bony rims which surround the eyes become wider and more prominent as we have remodeling of the bone and thinning of the soft tissues covering the orbital rims.  Fat from around the eye may start to protrude, giving us eyelid “bags”.  The eyelids appear to become elongated as soft tissues in the cheeks descend, uncovering the orbital rim.  Loss of bone, fat, and skin volume cause the ends of the eyebrows to descend as the clubs of the brows tend to elevate, giving us sagging skin and hooding of the upper eyelids.  Activity of the orbicularis oculi muscles, which surround the eyes, pull the lateral brows down and cause “crow’s feet” to appear.  Other depressors of the brow cause “frown lines” to appear, medially.

Efforts to restore the youthful eye can address the multiple factors involved in aging:

  • Botulinum toxin can relax the muscles which cause wrinkles around the eyes
  • Hyaluronic Acid fillers or fat injections can restore volume around the cheeks and eyes to recreate the smooth contours of youth.
  • Chemical peels, lasers, or microneedling can improve skin texture and complexion, restoring optimal light reflection and eliminating the tell-tale shadows of aging.
  • Ultimately, surgery can remove bulging fat, resuspend drooping tissues, and restore facial volume.
Written By: Anthony Bentley, D.O., FACS, FASLMS, FAAOA
Department Chairman, Otolaryngology – Head & Neck Surgery / Facial Plastics
Ferrell-Duncan Clinic / CoxHealth
Springfield, MO

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