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Dr. Gal Aharonov Facial Plastic Surgery Blog

Facial Plastic Surgery Blog by Dr. Gal Aharonov

Why do my eyes look tired?

April 8th, 2015

Tired looking eyes could be the result of several issues. Eyes can look tired because of too much upper eyelid showing on front gaze, the eyelid itself being too low in relation to the pupil of the eye, or too much shadowing and darkness around the eye. Shadowing could be caused by either genetic volume deficiency around the eye socket or aging which causes progressive volume loss around the eye. The skin could also appear darker either from the skin itself being pigmented, or by the skin being very thin and see-through with dark muscles and blood vessels underneath. Sometimes there is too much relative skin overhanging the upper eyelid causing the eye to look saggy and droopy hence tired.

The upper eyelid itself being too low is called ptosis and could be either genetic or progressive with aging. It could also be due to underlying medical issues or caused from previous eyelid surgery. Psuedoptosis is when the upper eyelid position is normal but there is just too much upper eyelid seen on front gaze leading to the appearance of the eyelid being too low. This could also be due to congenital or genetic decrease in volume, or due to progressive aging which could lead to volume loss and more upper eyelid showing. Look at some of your photos from when you were younger: was there less eyelid showing? if so it means you have had significant volume loss. Do your eyes look less tired when you first wake up in the morning and become progressively more tired looking throughout the day? You probably have volume loss around your eye.

Having a good understanding of what is causing the eyes to appear tired allows us to target those specific issues leading to a much more natural result.

Current options for Jaw Augmentation

March 28th, 2015

Most people undoubtedly want a nice straight jaw line. Some people were born with a great jawline and with aging started loosing jaw definition, other people just never had a great jawline to begin with. There are also differences in the aesthetic desires for a male vs a female jawline: while men mostly want a solid strong jaw, women are mainly concerned with the contour of the jawline and shadowing resulting from it. A female desirable jawline involves just as much soft tissue contour as it does the jaw bone itself.

A proper treatment plan involves evaluation of all these factors: past appearance of the jaw line, which component of the jawline needs to be augmented, aesthetic desires and balance with the rest of the face, and gender. Options for jaw augmentation revolve either around bony augmentation with implants such as angle of the mandible or chin implants, or soft tissue augmentation with either fillers or fat injections. With the evolution of filler options it is now possible to augment different components of the jaw by injectio of the filler in different planes. Deep filler injection on the bone can simulate the aesthetic result of a larger jaw bone while superficial filler placement can simulate augmentation of soft tissue such as fat loss.

I feel like my earlobes have shriveled up. Is it safe to use fillers to plump up my earlobes?

January 22nd, 2015

As we age, even our earlobes lose volume, causing our ears to look older and making some women feel self conscious about wearing their hair up or putting on certain earrings. Using a bit of filler in the earlobe is a quick and simple way to address that. A bit of filler in the earlobe can last for a long time, sometimes years. It can also add some support around piercings which can help prevent stretching of the piercings over time.

Does a one stage forehead reduction surgery stretch the scalp?

January 22nd, 2015

A one stage forehead reduction surgery, and especially the FROST technique, does not stretch the scalp much. The hairline lowering is accomplished by literally sliding the entire scalp forward to the location that developmentally it should have been the entire time. Using the tissue expander technique (a two stage forehead reduction surgery) actually stretches the top part of the scalp so it can cover a larger area. This thins out the hair on top of the head. So the major difference between the FROST surgery versus a two stage forehead reduction is a relocation of the entire scalp forward versus stretching the top part of the scalp. The hair density with the one stage forehead reduction stays the same.

Does a forehead reduction or hairline lowering surgery raise the eyebrows? My eyebrows are high enough and I would not want them any higher.

April 22nd, 2014

There is a huge misconception that lowering the hairline with a forehead reduction raises the eyebrows. That depends on the surgical method used. With my forehead reduction there is NO chance for the eyebrows to be higher. In patients that would like to have their brows raised it is possible to also perform a browlift during the forehead reduction procedure, but that is separate.

I had Grave’s Disease in the past and it left me with an upper eyelid retraction in my right eye. I had an orbital decompression with little improvement and really want to avoid further surgery. Is there anything I can do to improve the eyelid retraction nonsurgically?

April 22nd, 2014

Upper eyelid retraction is an extremely difficult problem to address and classically has only been handled with surgical release and elongation of the levator muscle in the upper eyelid. Depending on how the eyelid looks, either filler and/or botox can be used to try to lower the eyelid a bit. I have had mixed results with these techniques but they seem to at very least be fairly safe. The effectiveness is not universal though. If you do not want any additional surgery, using filler or botox in the upper eyelid might be a good option to try.

I had a chin implant placed years ago and it caused there to be a depression between my chin and lower lip. Is there a way to fix it?

April 22nd, 2014

Chin implants, while great, are not anatomically correct. They tend to be placed along the lower edge of the jaw bone but do not extend up high enough compared to a normal chin. This tends to create a depression along the mentolabial sulcus. This can be corrected surgically by augmenting this region with another implanted material, or can easily be fixed using a non surgical filler injection. The importance here is to recreate normal anatomy. If the filler or implant are placed in the wrong location, the chin can look even more unnatural.

Non Surgical treatment for sunken in eyes (Enophthalmos) with fillers

December 12th, 2013

Enophthalmos is a condition when the eyeball itself is sunk into the orbit too deep. This could be a congenital problem that one is born with, due to a disease process such as silent sinus syndrome, or a traumatic event such as a broken eye socket. This condition is usually corrected by placing tissue inside the eye socket to push the eyeball back out surgically. There is now a non surgical option of using injectable fillers to fill in the space and slowly push the eyeball back out. This could be done as an office procedure while the patient is awake and can take as little as a few minutes to perform.

What is Voluma and how is it different from the other fillers?

December 12th, 2013

Voluma is a newly FDA approved Hyaluronic Acid based filler distributed by Allergan. It has been available in Europe for years. It is approved for cheek volumization and lasts up to 2 years based on studies. Voluma has a slightly thicker more viscus consistency and displays more lifting capabilities, which means you can achieve more contouring with it compared to Juvederm Ultra. It might be too thick for areas such as the temples or lips, and is not a good filler for fine lines or wrinkles. It is meant for volumization. It is too early to tell if it is a good filler around the eyes. Classically the other available Juvederm formulations are not recommended fillers around the eyes.

Why is it that as the day goes on my eyelids look more and more droopy and my eyes look more hollow? If I get a good night’s sleep my eyes actually look good first thing in the morning but then get hollow progressively as the day goes on.

December 2nd, 2013

This is a very common question I get asked. When you wake up in the morning your face and eyes are more puffy as you have been retaining more water in your face. This extra volume fills in your loose skin and plumps everything up. As the day goes on your face gets less and less puffy causing your eyes to look more hollow and your eyelid skin to be more droopy. If you like how your eyes look first thing in the morning a good treatment is to add volume using a filler. This will keep your eyes looking fresh throughout the day. You will still have some fluctuations with swelling even with the filler, but it will still be fuller at the end of the day.