7 best treatments for tired eyes [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
Is there an easy way to tell if you can just do eyelid surgery or if you might need more than just eyelids, like a brow lift or even a facelift?

Dr. O'Brien (00:10):
Yeah, so the brow position, where your eyebrows sit in relation to the sort of bony rim of your sort of orbit is what helps define where its position is. And it's, most of the time in women, we like to see it certainly at or above the bony rim. It's not going to be true on everybody. And then on women, the outer part of the eyebrow ideally sits a little higher than the more medial part or the part that's closer to the nose, and that's also not true for everybody. Certainly ethnically people have different anatomy, but that's kind of a general, very soft expectation of the brow. Men tend to have a flatter eyebrow and a lower set eyebrow, and so that is something that I take a look at. Anytime somebody comes in and is talking about their eyelids, because sometimes they don't have a whole lot of extra eyelid skin, but their brow has just sort of settled lower, and sometimes just giving 'em a boost of their eyebrow clears up what they think is extra eyelid skin.

Dr. O'Brien (01:15):
Sometimes it's a combination of both and the eyebrow skin, which is a lot thicker and heavier than the eyelid skin, sometimes you have to get that up and out of the way so that you have a chance to then really be able to see your eyes well. And then as far as facelifts, yeah, when we look at the lower eyelids, sometimes what people see on there sort of at the lid cheek junction, which is where the eyelid meets the cheek, sometimes the changes there are more aging of the cheek and face than the eyelid. And sometimes, again, sometimes it's both. And so these are things that we just kind of look not only at the eyelids, but I look at everything to make sure the face would stay in nice harmony once we're done.

Eva Sheie (01:54):
What procedures do you often combine with eyelid surgery at the same time?

Dr. O'Brien (01:58):
Well, brow lifts and facelifts are probably the most common. I often do some fat grafting to the cheeks kind of in the area lower than the eyelids, not into the eyelids themselves, but into the front of the cheeks, and that often really smooths out that transition, again, gets rid of some shadows or what have you.

Eva Sheie (02:20):
Are there non-surgical tricks that you often try? Do you ever see someone and think, maybe we're not quite ready, but let's try this first.

Dr. O'Brien (02:29):
So there are peels that can be done to refresh the skin around the eyelids. Certainly we use a lot of Botox, sometimes adding volume to the area of the lateral eyebrow or the temple or the anterior cheeks, whether that's with filler, whether that's fat grafting, those kinds of things can, that added volume can often refresh the area around the eyes if it's not actually excess eyelid skin. But the whole region, we call it the periorbital area, but it's not just the eyes. It's as we've discussed, the brow position, your temples, your cheeks, all of those things play a role. And so there are a number of nonsurgical things that can be done to refresh the skin non-surgically if somebody's not quite a candidate or they just don't want surgery.

Eva Sheie (03:20):
What about dark circles? Is that a different issue? What causes the dark circle phenomenon and how do you treat that?

Dr. O'Brien (03:27):
Dark circles are challenging, and it depends on what it is that is dark. A lot of times what we see on the lower eyelids that would be surgical in nature are when those fat pockets start to bulge forward and the light shines down from above on someone's face, they'll get a highlight at the top of the bulge, and then they'll get a highlight at the top of the cheek, and then there's a shadow underneath their eyes that looks like a dark circle. But if you sort of flatten out the skin, you see that the skin itself is not dark, it's just a shadow. And that would be where a lower eyelid lift or a blepharoplasty would be corrective of the dark circle. As far as the skin itself, sometimes people have redness or darkness to the skin on their lower eyelids, and that's often from either allergies, sometimes we'll make them kind of chronically inflamed or dark. Sometimes if it's vascular in nature or little pink vessels, it can look dark.

Dr. O'Brien (04:36):
Sometimes lasers or things like that can help sort of make the skin color more uniform to get rid of the dark circles. And then sometimes people have a combination of both, and they've always had dark eyelids, and now they also have loose skin. And so again, we have to kind of sort through all of that and come up with the options. I would say that I often will talk to people about seeing an allergist or something to make sure that all of that, that management is maximized so that they can end up with a smoother, brighter look around their eyes.

Eva Sheie (05:11):
On this podcast, we bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.