If you are beginning to notice that the area under your eyes is getting darker and deeper you will know that your age is beginning to show. This area is known as Tear Troughs and is caused by a loss of soft tissue in the cheek area and a weakening in the lower eyelid of the orbital septum. This accentuates the bone which lies between the lower eyelid and the cheek.

Whilst there are many reasons, apart from the onset of age, for dark circles to show, if you have under eye hollows this is an area that is quite hard to treat surgically.

If you have tried all other options you may be tempted to have an advanced from of treatment using tear trough fillers. This treatment is proving very effective but must be performed by a qualified surgeon.

Treatment for Trough Fillers

A fairly thick filler must be used and it will be injected into the orbicularis muscle directly on the bone. It needs to be injected deeply enough so that the needle taps against the bone.

Pressure must be allowed to build up in the syringe barrel before the needle is withdrawn to avoid any filler being released in the wrong place . If this happens a small lump will occur.

After Effects

• The skin under the  eyes is very thin and bruising and slight swelling is common. However this will wear off after a few days.

• The results are immediate but will only last from 6-9 months and will need to be redone.

• Any lumps that may occur can be dissolved  by the surgeon if a hyaluronic filler such as Restylane or Juvederm has been used by administering a small injection of Hyalase.

• There is always a slight risk of allergic reaction but this should be tested before treatment.

The American Society of Plastic Surgeons (ASPS) was founded in 1931 and has become the largest plastic surgery association in the world. Its members are expected to maintain the highest ethical standards after they have achieved a minimum of six years surgical training of which three years are devoted entirely to plastic surgery.

However, in the United States any licensed Medical Practitioner can call him or herself a cosmetic surgeon without any training or practical experience.

Do not hold back on the questions, satisfy yourself that the medical facility and nursing staff is up to standard, and always ask about alternatives to the treatment your surgeon may recommend, his experience and the risks involved. Above all you should feel comfortable with the surgeon and have confidence in his or her abilities.

Questions To Ask Your Cosmetic Surgeon

• Who will carry out the procedure and what qualifications do they have for this particular treatment?

• What will be the cost of the consultation with the surgeon?

• What will be the cost of the procedure, including any care I may need after it?

• If there are any complications, will I have to pay to have them treated?

• Does the company providing the surgery have their own approved hospital?

Certified members of The Royal College of Physicians and Surgeons of Canada enjoy the same high standards and are recognised by ASPS.

If you have difficulty in locating a fully qualified and experienced cosmetic surgeon in your area or country it is best to ask your local doctor who should be able to give you a recommendation and advice.

Do not take cosmetic surgery advertisements at face value, they really do need to be thoroughly checked out wherever you are in the world!

Be sure not to forget the cross examination, its your looks that are at stake! 

If happens more than once it is no coincidence! Have a good look at yourself in the mirror and the chances are that you will see that your eyebrows seem to look fallen and there are bags underneath them.

This usually happens to both men and women between 40 to 60 years of age. The cosmetic treatment to restore that vigorous, calm and youthful look is known as eyebrow or brow lift surgery and can work wonders with your self esteem and is likely to last for many years without further treatment.

There are two alternative procedures depending on age, skin condition, hairline, etc.
Both procedures will require a general anaesthetic:

Open Brow Lift

An ear to ear incision is made on or just behind the hairline. In the case of men who are balding the incision is made along a forehead crease that will eventually hide any visible scarring.

The forehead skin is slightly lifted to gain access to the underlying tissues allowing the muscles and tissues to be reduced. This tightening of the muscles then lifts the eyebrows.

The incision is then stitched or clipped.

On average the Open Brow Lift procedure takes about one and a half hours from start to finish.

Endoscopic Brow Lift

This operation is more sophisticated than the Open Brow Lift. Three to five one inch (2.5 cms) long incisions are made above the eyebrows. A small flexible tube with a miniature camera attached is passed into the tissues allowing the surgeon to see and operate on those muscles that need to be removed or tightened.

The small incisions are then stitched or clipped with the brows lifted and held in place with stitches behind the hairline.

Recovery takes up to 14 days before being advised to return to work with the stitches removed about ten days after the operation. Most surgeons prefer patients to stay overnight in hospital after the surgery in the rare case of an unexpected development.

You are likely to be advised to sleep in an upright position for a week or so to help reduce the swelling, not to use any cosmetics and shampoo your hair daily.

It is important to attend any follow up appointments made with the surgeon or hospital.

Some Dos and Don’ts

Consider very carefully whether you need eyebrow lift surgery. All invasive surgical procedures carry a degree of risk however minimal.

Its important to have the correct surgery for your eyes. If, for example you have a blepharoplasty procedure , your eyes wont look quite right if the real problem is the eyebrow position.

Ensure that the surgeon you are considering for this surgery is a member of an approved medical association and has relevant qualifications and experience.

Check that the hospital is fully equipped to deal with any emergencies that may arise as a result of cosmetic surgery, and, of course, that it has a high standard of cleanliness and maintains proper hygiene procedures throughout the premises and not just in the reception and other areas on view public.

Most important of all you should expect your surgeon to take the time to build up your trust by explaining to you in detail the procedure and after effects of the surgery you are contemplating undertaking.

A successful result will leave you with renewed self confidence, remove that worried, tired look making you look years younger.

In fact heavy under eye fat, that looks like a pouch, can and does add years onto a persons age and if you feel you look older it makes you feel bad and it becomes a constant cycle that can even develop into depression.

Some people have this condition due to water retention in the under eye area, this can be treated with lymphatic drainage, but for others the cause could be genetics which has given them pads of fatty tissue just below their eyes.

The only recognized treatment that permanently removes fatty tissue or eye bags from under the eye is invasive cosmetic surgery, which is increasingly popular.

Transconjunctival Lower Eyelid Blepharoplasty

This procedure is performed through microscopic incisions, by removing the fat deposits from inside the lower lid. This can be done either with laser or any other fine cutting instrument.

The advantages

• There is no visible scarring
• Less chance of the lower eyelid pulled away from the eye (lower eye ectropion)
• More precise fat sculpture
• Less bruising and swelling

Disadvantages

The success of this procedure depends on the amount of fatty tissue to be removed. The larger the eye bag the more possibility there is of being left with an excess of skin which may form into wrinkles. Therefore this procedure is only normally performed on younger patients.

Transcutaneous Lower Eyelid Blepharoplasty

For older patients or those with more fat to be removed the procedure is performed under the lash line and then may be followed with a Chemical Peel or Laser Resurfacing to tighten up the area.

Healing Process

Recovery time varies from person to person depending on their ability to heal. There will be a certain amount of bruising and swelling but this should disappear over the course of a few days and the results are normally excellent. However, final results will not be experienced until approximately 6 months after the procedure.

The risks

As in all invasive surgery there are some risks.

• Infection – unlikely to be serious due to the sterile conditions of surgery.
• Continued bleeding – may necessitate reopening the wound and cauterizing the offending vessel.
• The wound may open slightly – not a great problem as the wound can either be taped or receive more sutures
• White cysts may form on the scar line – can easily be removed.
• Too much skin removed – dependent on the severity of removal further surgery may be required
• Too little skin removed – unsatisfactory result resulting in further surgery
• Too much fat removed – may leave a hollowed under eye look. This can happen gradually over years after surgery.
• Too little fat removed – may require further surgery.
• Excessive external scarring – this applies to those having Transcutaneous Lower Eyelid Blepharoplasty and can be due to a poor healing process on those with sensitive or damaged skin.
• Excessive internal scarring – this applies to Transconjunctival Lower Eyelid Blepharoplasty and can result in shrinkage of the internal lower lid resulting in distortion. Further surgery may help.

Therefore it is vitally important to do your homework when looking for a reliable cosmetic surgeon as the first thing to establish is whether your under eye bags are due to water retention or fatty tissue.

The procedures can vary from surgeon to surgeon and whilst it may be something you have decided to do and want it done now, you will get better results if you do thorough research.

I

• If your tattoo covers a large area of your body.
• If you have had the tattoo for a considerable period of time.
• If the pigment was not distributed evenly into the skin and smudging is evident this can occur if the tattooist was not a qualified professional.
• If you are amongst those people who have a longer healing rate.
• If the tattoos are on or around the eye area as the skin here is very sensitive.

Methods of Tattoo Removal

Excision: -

Suitable for small tattoos as the entire tattoo can be remove.

A local anaesthetic is administered to the area and the tattooed skin is removed surgically. The wound is then sutured and will possibly leave no noticeable scarring. Do check out the likelihood of this procedure leaving the area free of visible disfigurement with your medical adviser, especially if it is in the area surrounding the eyes.

Dermabrasion

The area is sprayed with a freezing solution and then sanded with a rotary abrasive instrument. The skin then peels off and is covered with a surgical dressing, as some bleeding will probably occur.

This procedure is not painless so be prepared if you decide to go this route. It will take some time for the skin to grow back and during this time it will not be an attractive sight. Attention must be paid to the regular change of dressings; hygiene and any sign of inflammation should be reported immediately to your Doctor.

Laser

Probably the best solution for the removal of cosmetic tattoos of any size and in any area of the body.

Some colored dyes react differently with black being the easiest to remove. The procedure is normally painless but a light local anaesthetic may be administered if the tattoo is in a sensitive part of the body. You will possibly need more than one treatment to entirely remove the tattoo.

Make sure that the surgeon who removes your tattoo is a specialist in laser surgery.

After Effects

It cannot be over emphasized that the correct aftercare will help to lessen the possibility of residual scarring. The treated area and its immediate surroundings should be kept clean and an antibacterial lotion applied.

A scab may form and when that has fallen off the redness will fade as the normal healing process takes place.

This may take some time depending on the individual. Infection is always a possibility with any surgical procedure so do not delay in reporting any signs to your doctor. There may be some residual scarring due to the method of applying the tattoo.

Costs

Suggested reading

Do You Really Want To Pierce Your Eyebrows?