The patient is a 47 year old woman who noticed wrinkling of the skin of her lower eyelid and the adjacent skin extending towards her hairline. She said it bothered her when she was not squinching the skin of her lower eyelids and was worse with squinching. Because of wrinkles at rest and the extreme wrinkles with squinching the patient said she had to apply makeup frequently and that, over time the makeup made her look bad because the makeup would crack. She didn’t note any other problems on her face.
The patient had laser treatment for wrinkles performed one time. Healing was relative quick and she was able to wear makeup at five days after her procedure which was performed comfortably under local anesthesia. She was very happy with her cosmetic result and thought it made her look a lot better despite the fact that her procedure was minor and a small part of her face.
Laser treatment is the gold standard in treating moderate to deep wrinkles of the face. In addition to erasing wrinkles, laser treatment in the lower eyelid area can also tighten skin to give a smoother, more youthful appearance. Once an even and smooth surface is achieved with a single laser treatment, makeup can last longer and also generally doesn’t lead to cracking as it had been doing in this patient prior to her procedure.
One of the effects of cosmetic surgery of which plastic surgeons are aware, is that once a problem that is “stealing the show” and making people look at it is gone, other adjacent part of the face are more easily seen and are therefore more beautiful. In this patient, there are no more wrinkles to fixate on and so one can then see the translucent beauty of the eyes themselves.
Face Lifts also Remove Wrinkles
Plastic Surgeons and patients both now refer to face lifts by just using the term “face lift”. But this procedure used to be termed “Rhytidectomy”, Latin for wrinkle remover. Prior to development of the laser, facelift techniques were the only way to remove wrinkles. Now that we have the laser to treat wrinkles, and more effectively so with the laser, facelifts are really used to lift tissue and to treat skin folding.
The Only Exceptions
There are two areas where facelifting techniques can smooth out wrinkles and they are in the Crow’s foot areas and in the area where the “parallel lines” can occur. The Crow’s foot area outside the lids and towards the temples has to put up with eye closure and even squinching or extreme eye closure on a constant basis and so it is no wonder that wrinkles can form over time in this area of extreme muscle activity. There are, however several plans of attack, depending on the severity of the wrinkles and whether folding has occurred.
Is it a Wrinkle, a Fold or Both?
When Crow’s feet exist as fine wrinkles, Botox can be of major benefit and is nonsurgical. The downside of Botox is that it only lasts about three and a half months. Botox can be part of a maintenance attack on wrinkles and Botox can also be used very successfully between the eyebrows to prevent furrowing and over the forehead to eradicate horizontal frown lines. But once wrinkles become established(i.e. deeper and permanent), Botox can do little to remove the actual wrinkles but, looking at the bright side can help wrinkles from looking worse when the area is flexed. When wrinkles become established, the laser gives the best chance to remove them.
But another aspect of the aging process can further affect the Crow’s foot area and that is laxity. As the brows descend, they can cause untoward effects about the eyes. One of those effects is folding within the Crow’s foot area. When folding occurs, the laser is not able to tighten Crow’s foot area skin like it can in the lower eyelid because the skin of the Crow’s foot are is quite thick. Folding can only be treated with a technique that unfurls or removes excess skin. That includes face lifting, brow lifting and skin removal via upper eyelid surgery (eyelid lift or blepharoplasty). The most powerful procedure in the list to treat Crow’s foot folding is the Brow Lift. With a Browlift, the Crow’s foot area can be completely smoothed out and the Laser is used in conjunction with the Brow Lift to eradicate even minor wrinkles in this area.
Back to the Face Lift
A nod must certainly be given to the face lift in possibly being able to improve on a patient’s Crow’s foot wrinkles and folding and can help some patients, especially when they don’t want or need a brow lift. During a face lift, the outer part of the orbicularis muscle that squinches the eye closed can be removed and this weakens patient’s ability to close the eye with extreme pressure but basic eyelid closure is preserved. This part of the muscle is not necessary and just causes wrinkles in the Crow’s foot area.
It’s Near the Eyelid!
The Crow’s foot are is just outside the upper eyelid. Should upper eyelid surgery become necessary when treating skin excess of the upper lid, the skin excision can be extended outward and into the Crow’s foot area. Therefore, skin excess and folding in the Crow’s foot area can be improved with upper eyelid surgery (upper blepharoplasy). When one extends the skin removal into the Crow’s foot area it is still difficult to see the scar because plastic surgeons can hide this scar in a crow’s foot wrinkle and the direction of pull within the underlying muscle (again the orbicularis) is not working on that scar to stretch it out and so the best scar can be obtained in this area that is generally not visible.
