Modern and physiological concepts of eyelid rejuvenation

UPPER EYELIDS When considering rejuvenating the upper eyelids, it must be understood that with age, the eyebrow (Table 1) gravitates downward, causing a pseudodermachalasis of the upper eyelids. This, in turn, is responsible for static crow’s feet, and with a receding hairline we get widening of the forehead. Because the eyebrow is low, it is raised to improve the appearance (in front of the mirror or when meeting someone) or field of vision. As a consequence, the frontalis, procerus and corrugator muscles hypertrophy and forehead wrinkles develop. For us, it is not advisable to routinely excise skin and fat pads from the upper eyelids. This procedure reduces the distance between the eyebrows and the eyelashes and creates a ‘sunken eye’ (Figure 1) and a contrast between the skin inferior to the eyebrows and that of the upper eyelids, which are different in colour, texture and thickness). In addition, it may prevent the a future brow lift because the patient would have lagophthalmia. A brow lift, on the other hand, may give a proper location and arch to the eyebrows (Figure 2), restore the original dis-