NEW YORK, NY (May 16, 2003) - For many people, the first visible signs of aging appear around their eyes. Eyelid surgery, or blepharoplasty, was the third most popular aesthetic surgical procedure last year, with 45 percent of eyelid procedures performed on people under age 51, according to the American Society for Aesthetic Plastic Surgery (ASAPS). However, traditional eyelid surgery, with its emphasis on skin and fat removal, is being reevaluated in light of new concepts for treating the aging face. An expert panel will discuss innovative approaches for upper eyelid surgery at ASAPS' Annual Meeting, May 16-21 at the Hynes Convention Center in Boston.

Attractive eyes look rested and alert, without hanging skin or puffiness. Patients seeking cosmetic plastic surgery for their upper eyelids usually want to get rid of the hooding over their eyes, which they feel gives them a tired or sad look; but today's skilled aesthetic plastic surgeon knows that simply removing excess fat and skin may not be the only answer. It has been observed that, as people age, they actually lose fat around their eyes and under their brows, and this eventually may cause a "hollowed out" appearance. That's one reason for the current trend toward fat preservation and a more conservative approach to skin and fat removal in the upper eyelids. In some cases, it may be necessary to add volume to the upper eyelid area in order to achieve the most youthful look.

"Each patient needs to be carefully evaluated for bone structure, descent of tissue and fat, and skin quality in the eyelid and surrounding areas," says panel moderator Malcolm Paul, MD, a Newport Beach, CA plastic surgeon and Past President of ASAPS. In achieving a youthful upper eyelid, he says, aesthetic plastic surgeons
may also employ techniques to elevate the brows, reposition or transplant fat, and immobilize the muscles that can cause future wrinkles with Botox injections.

"Many patients come to a plastic surgery consultation feeling certain they are good candidates for upper eyelid surgery, only to be told by their aesthetic plastic surgeon that what they really need is a brow lift," says Dr. Paul. "They see hooding of their upper lids, but they may not realize that it's the result of sagging brows." A brow lift, using incisions usually placed within the hair, reduces forehead wrinkling and frown lines, and lifts the eyebrows to a more pleasing position. This, in turn, can reduce hooding over the eyes.

In addition, says Dr. Paul, "The area below the brow, directly under the brow arch, is a highlight area that may benefit from the addition of volume with fat grafting. Adding this volume gives the eye area a beautiful contour and also accentuates the eyelid crease below," he says.

"What makes a beautiful eye is not only the eye itself, but what surrounds it, including the position of brows and the contours of the entire upper eye area," explains Dr. Paul. "Upper eyelid surgery is an important facial rejuvenation technique, but we now understand how to perform this technique even more effectively so that the surgical improvements we make today will create the best possible long term results."

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