SKN: What's so alluring about the eye area and getting it fixed?

Dr. Novick: While some may argue whether the eyes are truly "the windows to the soul," few would deny their enormous esthetic importance to our overall appearance. In Western culture, we relate to each other by looking first into the other person's eyes. The familiar expression, "seeing eye to eye," further attests to the significance of relating to one another through our eyes. For these reasons, whatever improvements we make in the esthetic appearance of our eyes carries a benefit that goes above and beyond the eye area. In other words, making the areas surrounding the eyes more attractive and youthful helps to rejuvenate our entire face.

SKN: How does the eye area age?

Dr. Novick: With the passage of time, the eye unit - which comprises the upper eyelids, lower lids and eyebrows - suffers from a number of different esthetic problems that result from chronic sun damage, genetics, gravitational changes, improper nutrition, smoking and alcohol or substance abuse. In our previous interview on non-surgical facelifts, I described how over the decades, the heart-shaped pad of fat that sits squarely over the cheekbone in youth shrivels and slides slowly down off the cheek and heads inward toward the nose. When this happens, the smile lines and "parenthesis" lines around the sides of the nose and on the lower cheeks and the "sad" lines surrounding the mouth and chin are all accentuated.

But the sinking fat pads may also give rise to profound effects in the appearance of the lower eyelid region. When in their proper place, the plump fatty tissue serves to physically intercede between the surface of the skin and the dark-colored blood vessels located below. So when they shrink and move downward, dark circles appear under the eyes.

When robust and present, these fat pads also buoy up the skin above and stretch it tightly. With their loss, the skin of the lower lid may become grainy and sunken-looking and "tear troughs" can appear. The tear trough (what doctors call the nasal-jugal groove) is a fancy description for the channel-like region located between the uppermost portion of the cheek and the bottommost section of the lower lid.

Having lost much of its youthful elasticity, the skin under the eyes fails to re-drape itself smoothly and tightly. Instead, like a balloon that has lost all its air after a long period of inflation, the skin may appear wrinkled and crinkly, like crepe paper. To make matters worse, an age-related weakening of the tiny, strap-like muscles located directly under the eyes may allow small amounts of the fat deposits that are normally hidden below them to herniate (stick out), giving rise to what doctors call "festooning," or in lay language, bulging below the eyes. So, as a result, a person develops dark, "panda-eye" circles, puffiness of the lower lid, wrinkled and crinkled skin, wrinkles and "tear troughs."

SKN: With such aging inevitable, what can we do non-surgically to rejuvenate our faces?

Dr. Novick: A combination of Botox Cosmetic and an appropriate volumizer, a volume replacement material, can significantly improve the above problems. Instilling two tiny drops of Botox directly into the baggy tissue below the eyelids has been demonstrated in many cases to diminish or soften the wrinkling and crepe-like appearance.

Using a technique bearing the cumbersome name of suborbital augmentation, the tear trough deformity and the sunken area immediately above it may be inflated with Radiesse (Juvederm Ultra Plus or Perlane can also be used). Suborbital augmentation not only raises the trough (the depressed area itself) but is also capable of compressing the crinkly area just above it (the region immediately under the eye) to diminish wrinkles and the crepe-like look and level out any bulges. At the same time, by re-volumizing the entire area, the blood vessels located below the skin's surface once again become much less visible, and the appearance of dark under-eye circles disappears.

SKN: What happens to the eyelids and eyebrows when they age?

Dr. Novick: Not immune to the aging process, the upper eyelids have their own problems. Excessive or redundant (sagging) skin on the upper lid, known as dermatochalasis, isn't just an esthetic concern, but when severe can actually interfere with vision. In most cases, however, it just makes the eyes look hooded and tired.

The position of the eyebrows is another casualty of Father Time. In young women, the inner half of the eyebrow lays directly over the rim of the bony orbit. Two-thirds of the way across in the direction of the temples, the brows flare upward above the browline and are buttressed by an outwardly projecting mound of fat. When this fatty tissue shrivels and flattens with age, the outer brows sink to the level of the rim of the orbit or even below it. The now downwardly directed outer third resembles the shape of a normal male brow and imparts a sterner look to the female face.

SKN: What non-surgical options do we have to help?

Dr. Novick: To remedy these changes, Botox Cosmetic may used for what has been called a "chemical brow lift." To weaken the downward traction of the muscles in this area — thatss in part responsible for the fallen eyebrow - Botox is injected directly under the outermost segment of the hairs of the eyebrows. Essentially, by giving an advantage to the upwardly pulling counterparts of the treated muscles, the sagging outer brow is lifted back up to its original position above the bony rim of the orbit.

The volumizers Juvederm UltraPlus and Perlane, have each been used successfully to both restore youthful fullness directly below the outer brow and complement the effects of the Botox. Both doctors and patients have noted consistently gratifying results when using these treatments to restore the eyelids and brows as well as cheeks, jowls, noses and lips, and dermatologists now refer to these treatments by the acronym RAVE, or Regional Aesthetic Volume Enhancement.

SKN: What are some final things we should know about non-surgical procedures?

Dr. Novick: Fees for lower lids and brows generally range between $750 and $1500 each. Lids and brows together usually take no more than 10 minutes to treat, and the results may last from eight to 12 months before a touch-up may be needed.

Got a question for Dr. Novick? Send him an email here info@skincare-news.com! Your question might be featured in an upcoming article.

Skincare-News.com thanks Dr. Novick for his invaluable expertise on non-surgical eye and brow lifts. Make sure you check out the other interviews in our seven-part series on non-surgical rejuvenation procedures. Check back with us often for additional exciting expert interviews and information!

The Non-Surgical Rejuvenation Series:

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Facelifts (Part 1)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Nose Jobs (Part 2)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Lip Enhancement (Part 4)

Talking Non-Surgical Neck Lifts (Part 5)

On Non-Surgical Chest Enhancement & Breastlifting (Part 6)

Chatting About Non-Surgical Hand Rejuvenation (Part 7)

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In addition to Dr. Novick's role as bestselling author, clinical professor of dermatology at The Mount Sinai School of Medicine in New York City and attending physician, he is also a fellow of the American Academy of Cosmetic Surgery (FAACS) and maintains a private practice in Cosmetic Dermatology and Cosmetic Dermasurgery on Manhattan's Upper East Side. He has been featured on many popular television and radio shows and lends his expertise to scores of major publications.