The part of the face that benefits the most from rejuvenation is the lower lid and upper cheek. When this relatively small area of aging is corrected well, the effect is quite disproportional to its size. Having a fresh look here can freshen the look of the whole face, and because it is completely natural, the reason for this is not apparent. This magnified benefit is unique and is similar the correction of the upper eyelid but even more so. The upper cheek is mentioned because it is integral with the lower lid in aging
For all of its importance it is unfortunate that lower lid correction is the most poorly corrected aspect of aging on the face. Healing here tends to be slow, partly on account of the structure but largely because the visibility of the lids means that even the smallest amount of residual swelling is seen. For this reason there is a tendency to opt for the simplest procedure possible to satisfy the desire to have the quickest recovery particularly for a ‘small area’. Accordingly a quick result is usually preferred to the best result.
Yet the lower lid is the one area of the face that benefits the most from having the best result.
I will explain all this in more detail because of its significance and my passion about correcting lower lids. After a lifetime of experience in refreshing faces and analysis of many different techniques I am pleased to have finally developed a combination of procedures that provide the definitive correction of lower lids, and with that the look of the face.
The soft tissue frame of the eyelids around the eye is what gives the eyes their expressive character. When we look at a person we look into their eyes to read them and in looking there the tissues that frame the eyes are automatically seen. The eye structures are seen more closely than the parts of the face outside that field of vision. Interestingly, when we look ahead our eyes are ‘designed’ to notice what is below. For this reason the lower lid and cheek below are seen more than the upper lid and forehead.
Accordingly, the configuration of the structures below the eyes is being registered in our subconscious while we are looking at that persons eyes. If the configuration here is a sign of youth we see a youthful person and if the configuration is that of tiredness we register that as older age. To give you an idea of how powerful is the impression we gain from this small area, if it is of aging, this impression overwhelms the look of the rest of the face that would otherwise be seen as youthful. That is why this area is so important to us when we want to look fresh, because the opposite holds true also. When this area is more youthful in its configuration than the rest of the face, peoples’ subconscious opinion is more positively influenced by this small area than the negative opinion given by the appearance of the rest of the face.
The outer structure of the lower lid is an upward extension of the cheek, whereas the hidden internal part of the lid is an extension of the eye structure. One of the characteristics of youth is that the lid is short and distinct from the cheek. But they visibly merge with aging as the lid extends lower down into the upper part of the cheek in the form of an eyelid bag while the upper edge of the cheek descends.
The standard treatment of lower lid bags is to remove the fat prominence underlying the bulge and then to tighten the lid to some degree.
The result of this treatment varies considerably; the reason for the variation is that the outcome is dependent on the upper cheek and how much it has dropped.
In this situation the cheek needs to be corrected at the time of the lid surgery. This requires a cheek lift, which is a bigger surgery than the lid. If this is not done when the cheek has dropped, while the lid bag may be improved, the resulting appearance of lacks the refreshing as the lid still looks long, i.e. aging because of the low cheek.
There is a ‘missing link’ in this area that is only now being appreciated.
This is the change of the bone where it forms the orbital rim at the top of the cheek. The bone actually shrinks and more so at the inner part. Having this understanding allows us to reassess the changes that occur with aging in the lid cheek area.
The most visible change is the increasing look of prominence of the lid bag on the nasal side. What is not immediately obvious is that the reduction of projection of the cheek directly below the bag prominence is what makes 3 apparent. In other words, when the under aspect of the bag becomes more apparent it gives the illusion of a larger and more prominent bag.
The treatment needs to change to accommodate this improved level of understanding.
The first step is to bring the upper cheek forward by restoring the missing bone volume of the orbital rim rather than removing the lid fat to camouflage the bulge of the lid.
It has been known over the years that people who have flat cheeks (on forward projection) and particularly people of Asian origin have a much greater tendency to the early appearance of lid bags. Inherently these people do not have much bone projection initially and so just a little reduction following early aging is enough to alter the balance between the lid the cheek.
Silicone cheek implants have been used over the years in some people to correct this imbalance, but these days fat injections have become much more popular. However, even fat injections, which are not difficult to perform, are not without some difficulties. But remember that the missing tissue is bone, not fat.
I have had an extensive experience over the last 10 years replacing missing bone of the face using coral. Yes coral, as it is a pure source of the bone mineral called Hydroxyapatite) and have placed this in over 500 patients to improve the structure of their cheek bones. .
In response to the need to have a small volume of coral to improve the correction of lower lid bags I developed a way to place this through the lid incision. In other words while the lid is being corrected the shrunken bone of the orbital rim and below can be replaced, with virtually no additional swelling or bruising.
That is why I call this ‘lower lid correction with a touch of Coral’. It is a major advance because the cause of the problem is now being corrected properly without major surgery to provide a lasting result of lid bags.
At the time this is being performed it is possible
Surgery cannot correct the quality of the skin that has resulted from sun damage and stretching, especially the fine lines. It is difficult to restore elasticity to skin.
As previously mentioned when the cheek has dropped more than a moderate amount a proper mid cheek lift is required to rejuvenate the look of the lid cheek junction. This surgery is considerably more than just lower lids, but then it does enable a significant improvement for anyone who has real cheek descent.
What is more, when the coral augmentation is performed it is a more comprehensive improvement than is possible through a limited lid access and so a more significant improvement of the entire cheek as well as the lid cheek area is obtained.
Some people, especially if they did not enjoy good bone structure when younger suffer from more strain on the ligament that supports the outer lid attachment and this weakens progressively with ageing.
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.