Helping People See Better — and Look Better, Too

A person’s eyes are sometimes regarded as the windows to their souls, and in truth, when we are communicating with someone else our own eyes are usually focused on theirs, and we glean lots of impressions from what we see. Their eyes may tell you they are happy, sad, tired, confused, disappointed, or any number of other emotions they may be feeling. We look at people’s eyes more than any other area of the face.

For your next few conversations pay attention to where your eyes travel, and you’ll see that this is true. This is different from when you are looking at your own face in the mirror: You tend not to look at your eyes nearly as much as you look at something else that bothers you, like a mole, crease, or zit that has stolen your attention. We tend, for the most part, to ignore these other things when we are talking to someone else.

Eyelid Surgery Is Popular

At ACENT, many of our Anchorage patients are seeking improvements in the way their eyes look. Sometimes their concerns are related to looking more tired than they feel or older than they feel. Some note that they have a family trait of fullness of either the top or bottom eyelids that they don’t like.

If there is too much skin on the upper eyelid, applying makeup can be challenging, or it doesn’t wear well throughout the day. Sometimes the hooding of skin touches their eyelashes, creating a sensation that there is something in their eye all the time.

Fine wrinkles form between the eyes, in the crow’s feet areas, and on the eyelids themselves. As we age, the forehead and eyebrows slowly sag, pushing extra skin onto the upper eyelid. This can lead to obstruction of vision in the upper field of view, as well as subconscious activation of the muscles in the forehead to pull the brows back up, causing forehead wrinkles and sometimes even headaches.

The lower lids can also sag, exposing the white part of the eyeball (we call this “scleral show”) and giving a rounded look to the eye. When the lower lid sags enough, tears do not flow properly toward the inside corner of the eyelids, and the eyes can water more easily.

Recommending Blepharoplasty

So, how do we look at a patient’s eyes clinically at our Anchorage practice and figure out what our recommendation for correction might include? During our evaluation, we look at the entire forehead/eyebrow/eyelid/cheek complex, because all of these facial features are interrelated, and changes to one can have a dramatic effect on the adjacent area.

For example, a patient may be focused on the excessive skin on their upper eyelid, thinking that the best thing is to remove as much of that skin as possible. But if that patient’s eyebrows are at the level (or even below) the orbital rim — the bony ridge above your eye — it is very possible that the better option would be to elevate the forehead and brow to where it used to be when that patient was younger.

Sometimes the eyelid skin is the only problem, and sometimes both are contributing to the eyelid appearance. Doing the wrong procedure can lead to an unnatural appearance, as well as difficulties with the function of the eyelid, which can sometimes be very challenging to correct.

In another example, the patient may be concerned about excess fullness of the lower eyelid. But removing the fatty tissue causing the fullness may increase the wrinkles of the skin. Removing skin may pull the lower lid down slightly, causing that scleral show I mentioned earlier. The lower eyelid follows certain patterns of change as we age, so the recommendations and techniques we use to correct concerns are markedly different for a 25-year-old than a 50-year-old.

Cosmetic & Surgical Techniques for the Face


For vertical creases between the eyebrows — the dreaded “11’s” — as well as crow’s feet creases, our favorite tools include BOTOX® Cosmetic, dermal fillers, and laser treatments. More aggressive surgery to correct these usually does not work well at all, so using the easy fixes is usually the best idea.

If the eyebrows need repositioning, our usual approach is called an “endoscopic brow lift.” This is done in the operating room, for patient comfort and safety, and for use of the necessary surgical equipment.

We make 4 or 5 small incisions behind the newhairline (we don’t shave any hair!) and using endoscopes and other instruments gently lift the forehead skin up, all the way down to the eyebrows, and suspend it in a better position, allowing it to heal there.

There is usually some minor swelling and perhaps some bruising, but 10 to 14 days after surgery the patient looks amazing! Patients ask frequently about having a deer-in-the-headlights look after this procedure, but in the many, many brow lifts that I have done, not a single patient has complained of looking over-lifted.


Eyelid surgery itself, called blepharoplasty, is usually done in our Anchorage office, using mild oral sedation medicine and local anesthesia. For the upper eyelids, we design our incisions to lie in the normal crease that most of us have when our eyes are open, thus hiding any evidence of having had surgery. Through this incision, depending on each individual patient, we can remove just enough skin, muscle, or even fat to provide a smooth and pleasant contour to the eyelid.

Most patients experience very little discomfort during the procedure, and even less afterward. Bruising is minimal — and just 7 to 10 days after surgery, the eyelids look great! It is a very satisfying procedure, both for the patient and for us.

Lower eyelid surgery has a few more variations than upper eyelid and again is usually done in our office. Depending on the problem we are trying to solve, we may use a completely hidden incision inside the lower eyelid or make an incision just below the eyelashes. Either way, when it is healed it is challenging to see, and as time goes on it seems to disappear completely.

In lower eyelid surgery, we remove a small amount of skin and the fatty tissue that is causing the bulges people hate so much. If need be, we can tighten the lower eyelid to make sure it maintains a good position next to the eyeball and directs tears in the right direction. Some older patients develop problems with their eyelashes turning inward or outward, and we can correct these issues easily.

We can also correct the contour of the lower eyelid with injections of dermal fillers, restoring a smooth curve between the eyelid and the cheek. Filler injections have continued to improve and sometimes this is a much better option than surgery.

A Word of Caution

Beware that there are lots of remedies sold to fix wrinkles and the “tired” look, most of which are either very temporary or just don’t work. I am not aware of any product that provides any significant improvement, other than those available in physicians’ and surgeons’ offices. Creams, serums, oils, and exercises may sound and feel good, but for the most part they only transfer money from your wallet to someone else’s. Beware of promises that sound too good to be true. They usually are.

Start by Figuring Out What You Want

As you can tell we have many, many tools in our toolbox to help with both the appearance and the function of eyelids, and that means we can offer several options to most patients. The first step is always listening to the patient. That helps us formulate recommendations and develop a plan, always with the goal of having happy and youthful eyes to enjoy for years to come.

So the next time you chat with someone, do a little analysis yourself. See what looks good and what is not so good. Become a keen observer of other people before you look in the mirror at your own eyes. We will be happy to help you look and feel your best.