Until recently the traditional plastic surgery operation called blepharoplasty has been the "Gold Standard" for rejuvenation of the eyelids to remove puffiness or lower eyelid bags, loose skin and hooding of the eyelids. More recent advances have included the use of the CO2 laser instead of a scalpel for blepharoplasty with a resultant decrease in the amount of bleeding and bruising and thus a shorter recovery. In addition, transconjunctival blepharoplasty, a technique done through the inside of the lower eyelid has improved results by avoiding an incision on the outside of the lower eyelid preserving eyelid support and natural shape. More recently, an internal eyelid ligament release called an arcus marginalis release, combined with fat grafting, has allowed plastic surgeons to permanently remove dark circles under the eyes. It is safe to say that in 2006, plastic surgical eyelid rejuvenation techniques are better, more effective, and when properly done by an experienced plastic surgeon more safe than ever before.

However, patients' desire to avoid surgery coupled with advances in non-surgical technology, and also influenced by the vast number of physicians with no surgical training entering the field of "aesthetic medicine", have resulted in many new non-surgical applications in the field of eyelid rejuvenation. While some non-surgical techniques have been dramatically successful e.g. Botox, many others are being marketed to patients and offered to patients before safety and effectiveness have been proven in clinical studies.

Two such techniques being promoted today are of concern to me.

The first is the use of soft tissue fillers to correct dark circles under the eyes. Many physicians are now injecting fillers like Restylane, Radiesse, Sculptra, Cosmoplast, Cosmoderm, Hylaform and others into the dark circles under the eyes to plump the dark circle. While acceptable cosmetic results can be achieved, the risks of injury to the eye are unacceptable, not only in my opinion, but the opinion of the manufacturers of the fillers. Companies that make the fillers recommend that the fillers not be injected around the eye. Unfortunately many doctors are not heeding these warnings, I assume out of ignorance of the vital structures that lie beneath the eyelid and can be damaged by the needle, or lack of concern for their patient's safety. It is not a matter of if, but when a patient will be blinded by this technique. If you would like to read the unfortunate experience of many patients who have been injured by filler injections around the eye check the following link:

The second technique that concerns me is the non-surgical blepharoplasty or eyelift performed by using a radiofrequency skin-tightening machine on the eyelids, directly over the eyeball. Astoundingly the demonstration on a web link showed a doctor performing this procedure with no eye protection for the patient. Radiofrequency is a high-energy heat source that shrinks skin by heating the deep dermis. Sophisticated cooling devices are used to cool the skin as the radiofrequency energy passes through the skin so that the skin is not burned. Were the eye exposed to radiofrequency energy the eye could be severely injured. Thermage, one such radiofrequency skin-tightening device has already been shown to melt fat beneath the skin resulting in permanent defects or depressions in the skin. I am concerned about the effect of such high-energy heat on the delicate eye structure and the fat and muscles beneath the eyelid. The device being promoted had a suction mechanism that pulled the eyelid up into the radiofrequency head and thus presumably avoided radiofrequency irradiation of the eyeball, but the patient had no eye protection. Noteworthy is the fact that the doctor performing this procedure was not a plastic surgeon and I assume was likely lacking in an intimate knowledge of the surgical anatomy of the eye and the serious complications and their management if they were to occur.

Unfortunately it is up to you, the patient to educate yourself and avoid unproven, risky new techniques that promise the miracle of non-surgical eyelid rejuvenation or blepharoplasty. Your safest course is to consult an expert. Seek the advice of an experienced board certified plastic surgeon when considering eyelid rejuvenation, blepharoplasty or eyelid lift. An experienced up to date plastic surgeon will be aware of which non-surgical facial and eyelid rejuvenation techniques work and are safe. Avoid the hype and marketing-if it sounds too good to be true it usually is. With thousands of physicians with no plastic surgical training entering this field every year these are dangerous times. Do not pay to become an experimental subject. Caveat Emptor.

Dr. Brooke Seckel