When is Eyelid Surgery Better Than Botox?

Our eyes can reveal our age and make us look tired. They are usually the first noticeable signs of aging. Now that we are wearing masks to protect us from Covid-19, as well as engaging in more Zoom conferences, our eyes are even more on display. Board-certified plastic surgeon, Dr. Charles Slack, will restore your youthful appearance with a customized treatment plan for addressing your goals in the eye area. Botox, eyelid surgery and browlifts can all improve the appearance of the skin around the eyes but do so in very different ways. Botox® Cosmetic treatment is well known for improving the appearance of wrinkles around the eyes (crow’s feet) and elevating the eyebrow by temporarily paralyzing muscles around the eye that contribute to these problems. Eyelid surgery, also known as Blepharoplasty and browlifts, surgically removes the excess skin and fat (in the case of a blepharoplasty) that make the upper eyelids look tired and puffy.

Botox® Cosmetic, Jeuveau®, and Dysport® are neurotoxins that are designed for the temporary improvement of moderate to severe lines caused by muscles used for some facial expressions. Using these products does not paralyze the whole face, just selective portions of facial muscles in order to achieve an improvement in appearance. A common fear is that using neurotoxins will create a “frozen” look. This is not the case. With selective injections by a skilled injector, treatments are individualized to each patient with specific goals in mind. This is particularly true for treatment around the eyes. Botox injections are effective at providing smoother skin and elevating the eyebrow (which can reduce the amount of excess upper eyelid skin) producing a refreshed, yet natural appearance. Because Botox is gradually degraded and eliminated by the body, the paralyzation and hence the result is temporary. Treatments need to be repeated every 3-6 months depending on how long it lasts in you. This is both the good and the bad of neurotoxins. If you do not like the way you look, you are not stuck with it for life. However, if do you like what it does for your appearance, you must repeat the treatment. Deeper lines and lines that are present without any facial expressions, may not be completely eliminated with neurotoxins but will usually look better.

As our eyes progressively age, our eyebrows begin to drop resulting in excess upper eyelid skin and a tired, “hooded” appearance. The amount your eyebrows have fallen will determine whether an upper eyelid lift (upper blepharoplasty), a browlift (forehead lift) or both are needed to achieve the rejuvenated appearance you desire. Many patients believe that they need a blepharoplasty when they begin to notice excess upper eyelid skin. However, as you age, the skin on your forehead begins to stretch, causing the eyebrows to drop and excess upper eyelid skin to appear. The amount your eyebrow has fallen will help determine the better option to rejuvenate your youthful appearance. To demonstrate this on yourself, just lift your eyebrow up with your fingers and notice how much improvement there is in the amount of upper eyelid skin.

As our skin ages, it also becomes thinner and easier to see the “puffy” fat pads and dark vessels that appear under our eyes. Lower eyelid surgery (lower blepharoplasty) utilizes a discrete incision along the inside of the eyelid to remove fat from underneath. While the eyes do continue to age after any facial cosmetic surgery procedure, the signs of aging become much less obvious by addressing the folded, excess tissue.

To answer to the question blepharoplasty or Botox, if you have moderate to severe skin excess around the eyes, cosmetic surgery will most likely be required. Botox, however, is a suitable treatment for mild to moderate wrinkling between and around the eyes and can provide some elevation of your eyebrow

thus helping to reduce the appearance of excess upper eyelid skin. Dr. Slack would be happy to go over your options and create an individualized plan for you through an in-person cosmetic consultation. To schedule a consultation, contact us.