why sad eyes ?

Nasojugal crease, tear trough deformity, nasojugal groove, bags under eyes, under eye hollowness

In the young individual the transition between lower eyelid and cheek is imperceptible. The dividing line between these areas in older individuals is the nasojugal crease also called the nasojugal groove (term first used in 1961) or tear trough (term first used in 1969). It is an early sign of aging around the eyes, lending a fatigued and aged appearance to the face. As part of the aging process ligaments that fix facial skin to the underlying facial bones thin and lengthen or stretch, facial bones recede back and facial fat shrinks. This results in the drooping of facial skin and appearance of laugh lines, jowls, nasojugal creases, eyelid bags etc.. The skin within the nasojugal groove or crease becomes thinner and/or darker in color than the slightly lower nose or cheek skin. It can also seem deeper or be more visible if there is protrusion of fat into the lower eyelid. The aging process starts near the nose as the tear trough and progresses outwardly towards the same side ear becoming what is called the palpebromalar groove.

THE RELIABLE SOLUTION : LOWER LID BLEPHROPLASTY

The term “lower blepharoplasty” includes a collection of surgical techniques that aims to improve the appearance of the lower eyelids. Historically, lower blepharoplasty was a reductive procedure in which skin and/or fat was removed in order to reduce lower eyelid wrinkles, skin redundancy, and fat bulges. While fat and skin excision is still performed with modern lower blepharoplasty , present trends follow a tissue-preserving philosophy that may include orbital and sub-orbicularis fat repositioning and fat transfer techniques to restore apparent volume loss associated with facial aging. In the early 2000’s, hyaluronic acid-based dermal fillers emerged as an off-label means of lower eyelid and infra-orbital volumization. Laser energy and light-based treatments have also been applied to the lower eyelids, providing non-surgical lower blepharoplasty options or non-surgical adjuncts to incisional blepharoplasty

Patient Selection

History A thorough medical and ophthalmic history is obtained prior to cosmetic lower blepharoplasty including: 1. Current illnesses 2. Medication list 3. Ophthalmic medications, lubricants, and contact lens wear 4. Drug or latex allergies 5. Dry eye symptoms 6. Social history (smoking, occupation, sun exposure) 7. Description of previous facial, ophthalmic, and eyelid surgery and procedures 8. The patient’s goals and expectations are discussed

Physical examination 1. Visual acuity, pupillary exam, extraocular motility. 2. Tear film and ocular surface evaluation 3. Presence of Bell’s phenomenon 4. Blink rate and strength 5. Presence of lower eyelid laxity and canthal tendon dehiscence 6. Presence of lagophthalmos 7. Skin evaluation (Fitzpatrick skin type, rhytidosis, dyschromia, skin redundancy, lesions) 8. Presence of steatoblepharon, infraorbital hollowing, tear trough deformity, malar fat atrophy 9. Globe prominence and globe/maxilla relationship (presence of negative vector) 10. Asymmetries, orbital dystopia

Standard view external photographs are obtained prior to surgery