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BEST ways to treat Under-eye Aging — Transcript

by DrAmirKaram · 4,404 words · 621 segments · language en · Watch on YouTube

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0:00hi everyone I'm Dr Amir Karem board
0:02certified facial plastic surgeon and
0:04founder and creator of care MD skin I
0:06specialize in facial Rejuvenation which
0:08basically means I help people look as
0:11young as they feel and today we're going
0:12to talk about an especially important
0:14and very common topic which is the
0:18treatment and management of the lower
0:19eyelid region people have tons of
0:22questions about this because what
0:23ultimately happens as this area starts
0:26to get aged or through genetic factors
0:28you start to look tired and nowhere does
0:31the Aging or fatigue show more than at
0:34the level of the lower eyelid and this
0:36is an area that I think based on all the
0:39different types of treatments that are
0:40available we are still left with a lot
0:43of questions on how to properly manage
0:45this area and in order to do that I'm
0:47going to empower you all by first
0:49understanding what Young looks like what
0:52are the expectations of a young looking
0:55lower lid number two we're going to look
0:57at what aging looks like or when
0:59genetics has a role in this area and
1:01then number three we're going to start
1:03to look at what are the different
1:04components that are involved in aging
1:06this particular region leading to the
1:09darkness and the hollows that we see
1:10underneath the eyes and then finally
1:12we're going to look at the tools that
1:14are available to treat this region we're
1:17going to look at things from fillers all
1:19the way through surgery and we're going
1:21to understand specifically where those
1:22tools fit in the Continuum of treatment
1:25so that you will be able to drive your
1:29own ship and know how and when to treat
1:32these specific issues and problems so
1:35that you don't get misguided or misled
1:37and do things that are not necessarily
1:39going to treat the particular problems
1:41that you're interested in this is a
1:43wonderful topic and a great piece of
1:44information to not only really absorb
1:47but also to share because I think what
1:49is going to follow will Enlighten you
1:51and feel very very common sense to you
1:54as well as especially when we show all
1:55the different examples of how these
1:57Concepts come into play alright folks
1:59without further Ado let's break it down
2:03foreign
2:05so let's start off by understanding what
2:07a youthful ideal lower eyelid should
2:11look like and this is what it comes down
2:13to when we think of young people when we
2:15think of Youth we think of not looking
2:18tired we look like we're not Haggard we
2:21look bright fresh and attractive those
2:24are the qualities of a youthful lower
2:27eyelid and what happens to cause that is
2:31basically there is a parameter called
2:33the lid cheek Junction and that's the
2:36distance between the eyelid and the
2:38cheek and you can see this on the front
2:39view and you can see this on the profile
2:42view and what you're seeing there is
2:44that the distance between the eyelid and
2:46the cheek the lid cheek Junction is
2:47short and what happens is when this
2:50distance gets longer the eyes start to
2:52look more Hollow Etc but let's focus for
2:54a moment on the characteristics of a
2:56youthful lower eyelid so number one a
2:59short eyelid cheek Junction I bet you
3:00haven't necessarily heard that term
3:02before but once you see it in action
3:04it'll make all the sense in the world
3:06number two you see a lower eyelid that
3:10is generally speaking on the fuller side
3:13you don't see deep Hollows you see eyes
3:15that basically have a certain level of
3:17volume and that volume contributes to
3:20eyes that look more fresh and healthy
3:23this is very important and it's going to
3:25tie directly to the tools in our toolbox
3:27number three what you see in the lower
3:30eyelid of a young person is no extra
3:33skin basically just the proper amount of
3:35skin that will allow you to look up with
3:38your mouth open which basically puts the
3:39skin on stretch without causing the
3:41eyelid to Evert forward that's the bare
3:43minimum that you need and that's
3:45typically the amount that normal
3:46youthful lower eyelids have you also
3:49don't see the presence of bags this the
3:51puffiness under the eyes and we all know
3:53what that looks like so the lower eyelid
3:55area of a young person can be
3:57characterized and summarized as a smooth
4:01mostly convex or flat lower eyelid
4:05segment that transitions beautifully
4:08into the cheek without having any sharp
4:12depressions Hollows puffy Contour
4:14irregularities and extra skin hanging
4:17over now we all know what that looks
4:20like we've seen it a million times we've
4:21seen it in ourselves if you happen to be
4:23a little bit more mature in the aging
4:24process or have the genetics for you
4:26know exactly what I'm talking about now
4:29let's talk about how the lower eyelid
4:31ages
4:34now it's very important to understand
4:37this is the key
4:38the lower eyelid region ages with two
4:43factors happening simultaneously number
4:45one
4:46is loss loss in the realm of lower
4:50eyelid fat there is a fat pad that sits
4:53underneath the bone that transitions
4:55into the cheek called the soup that
4:57stands for the sub orbicularis oculi fat
5:01pad which just basically means
5:02underneath the orbicularis oculi muscle
5:04now that fat pad creates a beautiful
5:06smooth transition from the Bony eyelid
5:09down to the cheek what you see in eyes
5:11that have aged is that fat pad starts to
5:14diminish and as a result of that eyes
5:16start to look Hollow so the hollowing
5:18that happens goes from the corner of the
5:20eye the medial canthal region all the
5:23way to the outer segment of the eye the
5:24lateral cancer region so this entire
5:26orbital Rim you start to see this
5:28Crescent shape outline of the bone the
5:30other aspect so this is loss right minus
5:32here this is what's happening minus now
5:34there's a there's an addition happening
5:36with age as well in the addition it
5:38comes in the way of soft tissue addition
5:40is either excess skin which is termed
5:45dermatochalasis again fancy word for
5:47just excess skin of the lower eyelid
5:49area and then number two is in some
5:53cases and not at all there's puffiness
5:55so what appears to be an excess amount
5:57of fat now I want to be really clear
5:59because I just made two statements that
6:01might might seem contradicting on one
6:04end I said you're losing fat on the
6:05other hand I said you might be gaining
6:07fat but I want to be clear everything
6:09I'm saying about loss is happening from
6:11the orbital Rim down what's happening
6:13with excess fat is from the orbital Rim
6:15up to the eyelashes that's the true
6:18eyelid everything below that is the
6:21eyelid cheek Junction it has nothing to
6:23do with the eyelid so you're losing fat
6:25in the lower eyelid cheek Junction
6:28region and in some cases you're getting
6:30this puffiness that's coming forward and
6:32I'll explain that anatomy in a moment so
6:34aging is a combination of excess soft
6:38tissue and deficient fat that's the
6:43combination that creates the lower
6:45eyelid to look tired Haggard and
6:49darkened and for the most part not as
6:51attractive and bright as it did when we
6:54were younger all right so let's keep all
6:57that in mind and you see the images to
6:58to support that and you have it really
7:01clear in your head what that looks like
7:02so I want to point out something and I
7:05want to re-introduce this topic and that
7:08is the eyelid cheek Junction remember
7:09youth is a short eyelid cheek Junction
7:11aging is a long eyelid cheek Junction
7:14the distance increases when these
7:16factors that I just mentioned are
7:18happening simultaneously so as we go
7:21into the tools and we start to see some
7:24before and afters and we start to
7:25discuss how this all happens in action I
7:28want you to pay careful attention to the
7:31eyelid cheek Junction in these cases
7:33[Music]
7:35all right so let's open up our toolbox
7:38and let's see what's inside of it so
7:40when it comes to the lower eyelid region
7:42I am talking about specifically the way
7:44I do it but I think the way I do it is a
7:46pretty good way because the results
7:48speak for themselves and you'll see it
7:50understand the logic that is part of my
7:52overall Paradigm so number one we have
7:55tools to replace volume what are those
7:58tools filler fat transfer two main ways
8:02you can replace volume by those two
8:03components now we have the excess aspect
8:07right how are we going to treat the
8:09excess you've got excess skin and then
8:12you've got excess fat well excess skin
8:14has its own tool and excess fat has its
8:16own tool put all that together after
8:18you've properly assessed the lower
8:20eyelid region you put the tools together
8:22you treat each of these aspects with the
8:24proper tools and guess what at the end
8:26you've got this beautiful restoration of
8:29the lower eyelid segment and you not
8:32only look more youthful and fresh but
8:34you look like yourself you don't look
8:35different you don't look augmented the
8:37shape of your eyes haven't changed and
8:40this is key and along the way you've
8:42actually decreased the likelihood of
8:44complications as a result of this
8:47particular approach so let's break it
8:49down so tool number one is our volume
8:51augmenters filler so filler usually
8:54comes in the way of hyaluronic acid
8:56those are popular brand names like
8:58wrestling and Juvederm now I'm going to
9:00say this at the time you watch this
9:01video there could be many many more
9:04fillers that are available and so I'm
9:07just going to speak about this in
9:08general terms not the specific brand
9:10names that you you may hear about or
9:13what happens to be hot for that
9:14particular issue at the time that you're
9:16watching this so let's just keep this
9:17broad hyaluronic acid fillers are made
9:19up of a naturally occurring part of the
9:22body called hyaluronic acid now
9:24hyaluronic acid in its natural form
9:26breaks down in about 24 hours if you
9:27were to inject it into into the body so
9:29what the manufacturers do they cross
9:31link these together in that process of
9:33cross-linking basically creates a
9:35situation where it's harder for the body
9:36to break down now as great as all that
9:39sounds
9:40there is a negative with hyaluronic acid
9:42and I'm going to go through all the pros
9:43and cons the negative of hyaluronic acid
9:46fillers is that if you inject too much
9:49of it the nature of the hyaluronic acid
9:52is that it absorbs water and when you
9:54inject it into an area that's thin like
9:56the lower eyelid it becomes puffy and it
9:59actually becomes boggy and blue looking
10:01it's a phenomenon called the tinyl
10:03effect in addition they don't generally
10:05speaking go away the way fillers go away
10:08in other parts of the of the body in the
10:10sense that you might always see a trace
10:12of that filler under this area and if
10:14you happen to overfill that region well
10:16guess what it's going to look pretty
10:18weird even two three four five ten years
10:20out super important to note and how you
10:23know it looks weird is there's a
10:24generally speaking a little bit of
10:25discoloration there and it's a little
10:27bit puffy now how I suggest you use the
10:32hyaluronic acid fillers for the
10:35treatment of volume loss is very simply
10:37this if you have mild volume loss
10:39meaning there's just a little bit of
10:41volume loss mostly in the teardrop just
10:43this corner here
10:44it should require between a quarter to a
10:48third of a syringe of filler per side
10:50and that's it if you use that quantity
10:53and really use it like once a year or
10:55once every other year
10:56guess what you probably aren't going to
10:58see the complications or the issues that
11:00I just described and it'll be a proper
11:03treatment really good treatment for that
11:04particular area now who benefits from
11:06this typically people in their 30s for
11:08the most part maybe early 40s if you're
11:11kind of losing volume in a little bit of
11:12a slower rate so what happens if the
11:15volume is a little bit greater it
11:17follows you know all the way around the
11:19orbital Rim which it will through the
11:21general evolution of volume loss in my
11:24opinion fat transfer is the way to go
11:25here because in order to treat this
11:27whole region you're going to end up
11:28using almost a full syringe per lower
11:30eyelid region and this is where things
11:32get a little bit messy because all of
11:34that hyaluronic acid into that area
11:36causes puffiness and swelling which
11:38you're not going to like the look of it
11:39especially if you end up doing it two or
11:41three times in a row which you will
11:42because when volume loss is that
11:44significant you're going to want to fill
11:46that area you know until it's it's full
11:49now the problem also becomes with the
11:51fillers is we get greedy we want to fill
11:53that area up to its maximum level but
11:55guess what the normal lower eyelid level
11:57in a 20 year old and 30 year old is
11:59actually a little underfilk there's a
12:00natural hollowness that happens under
12:02the eyelids that's okay to have you
12:04don't need to fill it all the way up to
12:06the hilt when you do feel it it's just
12:07supposed to be a little bit better now
12:09same goes for fat transfer fat transfer
12:11I like a lot now let's talk about that
12:13for a second that's my you know
12:14augmentor replacement of choice because
12:18it's natural it comes from our own body
12:20there's no inflammatory process to break
12:22it down your body accepts it it doesn't
12:24reject it and because of that what ends
12:26up happening is it it when you transfer
12:28it from the stomach or the thighs
12:29wherever you're taking the fat from two
12:31injectors this area it becomes a
12:34permanent part of that region now I did
12:36not misspeak there fat transfer is a
12:38graft graphs when they're taken from one
12:40part of the body put into another if
12:42they're done properly your body will
12:43accept them and they will become
12:44permanent so fat transfer is a permanent
12:47way to replace lost volume and if it's
12:49done in a very very proper way with an
12:53experienced injector it's going to look
12:55beautiful and it's going to look subtle
12:56and it's not going to look overdone now
12:58I'm going to just say this for a second
12:59this is the piece to keep in mind before
13:01you just run out and say oh I'm gonna go
13:03get a fat transfer fat transfers are
13:05difficult to perform I hate to say it
13:07and this is it's nothing new it's been
13:08around for 40 50 years but up until this
13:11date very few surgeons have really
13:13dedicated themselves to becoming
13:15proficient and good at fat transfer
13:16which I can't understand because it's
13:19such an important part of of you know
13:21the facial Rejuvenation process
13:22especially in the eyelid area I do them
13:25every single day I've been doing them
13:26every single day for almost 20 years I
13:29don't get lumps and bumps I don't
13:30overfill the area we generally speaking
13:32have a very smooth course with them it
13:35works every single time it's a beautiful
13:36treatment so I'm speaking from my own
13:38experience now you if you're going to
13:41replace the volume in that area with fat
13:42transfer it's up to you to make sure
13:44that the surgeon you choose knows what
13:47they're doing in that area you've got to
13:48see lots of before and afters and you
13:50have to really really trust the attitude
13:53and skill level of the particular
13:55surgeon all I'm going to say about that
13:57now let's open up the other side of our
13:58toolbox how are we going to treat the
14:01excess skin and how are we going to
14:02treat the puffiness now this is
14:04something that again is going to sound
14:06super logical right if you have excess
14:08skin you're going to snip the extra skin
14:09you snip the extra skin by a technique
14:12that I perform called a skin pinch I'm
14:14not the only one who performs this I'm
14:16just terming it the way I term it in our
14:18practice it's called a skin pinch which
14:19just basically means we pinch the excess
14:22skin in that area and then simply trim
14:24the excess skin now the trick of that
14:26procedure is knowing how much skin to
14:28leave not taking too much because if you
14:30take too much the eyelid will pull down
14:32if you take the proper amount you
14:33literally have removed the extra skin in
14:36that area and that sloppy kind of loose
14:39look in that region disappears and it's
14:41a very very simple procedure to recover
14:44from and it is beautiful when it's done
14:48now I'm going to preface it by saying
14:49this again in my practice I would never
14:52do a lower eyelid skin pinch or
14:56blepharoplasty without a fat transfer
14:59and the reason is because it's almost
15:00impossible for you to have extra skin
15:02under your eyes and have that aged
15:05hollowed look without having volume loss
15:07and if you don't replace the volume
15:09which I consider kind of Paramount
15:11you're still going to look tired because
15:13the eyes will still be hollowed and
15:14sunken you might have less skin so
15:16there's no point to doing it without
15:17volume augmentation this is really
15:19important I've learned it the hard way
15:20I've done it on certain patients without
15:22doing the fat transfer and it's always
15:24come back to bite me it's probably been
15:26seven eight years minimum that I've
15:29refused to do a lower eyelid surgical
15:31procedure without doing a fat transfer
15:33in addition to it that's again my sort
15:36of learning experience I'm sharing with
15:37you you share that perspective with it
15:39with your surgeon and hear their
15:40thoughts on it but that's how I do it
15:42now taking out extra skin that's a skin
15:45pinch now what happens when you have
15:46puffiness under the eyes so this is an
15:48important kind of anatomic point to
15:49understand having puffiness under the
15:52eyes or the fat pads that's not the same
15:54as saying that that you have suddenly
15:57grown extra fat in that area that's
16:00orbital fat that's the fact that that
16:01lines the eyeball inside the eye socket
16:04it's there to protect your eyes from
16:06bouncing around against the the Bony
16:08walls of the orbital socket but here's
16:10what happens some people have a weak we
16:13call a septum that divides the orbital
16:15compartment with the eyelid it's just
16:17basically you know just think of it as
16:18like a wall and that wall is made up of
16:20a tissue fabric we call the septum so
16:22when the orbital fat pad puts pressure
16:24on the septum it starts to bulge forward
16:27and it creates what's a condition called
16:29pseudo bags which just means means that
16:32it's not an actual bag it's just
16:33basically what appears to be and that
16:35pressure on the septum happens because
16:37some people genetically have a weaker
16:40orbital septum and as a result it pushes
16:42forward with age or genetics now
16:45how are we going to treat that there's
16:47several different surgical procedures
16:48that are available for that all under
16:50the the umbrella of lower eyelid
16:52blepharoplasty now in my practice I
16:55perform a technique called a trans
16:57conjunctival lower eyelid blepharoplasty
16:59and what that means is that I pull the
17:02eyelid down and I go from the inside of
17:03the eyelid to get to that fat pad and
17:06basically just trim a little bit of that
17:07puffy fat pad away so that it doesn't
17:10keep that pressure on the septum and it
17:12basically makes the the appearance of a
17:14bag disappear now the reason of going
17:17from the inside of the eyelid is because
17:19the anatomy of the lower eyelid is that
17:21their skin then there's muscle and then
17:22there's a septum and then there's the
17:23fat so if you're going from the inside
17:25you're never touching the muscle of the
17:28lower eyelid area and that enables the
17:31lower eyelid to maintain its strength
17:32and integrity so you don't get that
17:34issue or you get a lot less likely of
17:36the issue of the eyelid pulling down
17:38that's a important you know General
17:40point about performing this with safety
17:44absolutely in mind so so when I perform
17:46a lower eyelid procedure where I'm
17:47taking out fat I do it from the inside
17:49of the eyelid now there are other
17:50techniques called transcutaneous which
17:52means they go through the outside of
17:53this area and then they go down into the
17:55muscle and they remove the fat pad that
17:57way now the problem with that is that
17:59there's a higher chance of the eyelid
18:01pulling down and therefore a lot of
18:03Surgeons will then take the eyelid and
18:05then tether it up here called a
18:07canthopexy to support the lower eyelid
18:10so that doesn't happen I don't like
18:11those type of procedures because it ends
18:14up changing the shape of the lower
18:15eyelid and to me that's a big No-No
18:18that's a non-starter we need to keep the
18:20essence and the spirit of the eyes
18:21completely untouched so
18:24transconjunctival lower eyelid
18:26blepharoplasty is my tool for removing a
18:28fat pad skin pinch is my tool for
18:30removing excess skin and in a lot of
18:32cases those are combined in many cases
18:35it's just the skin pinch alone because
18:36it's more common to have excess skin
18:38than it is to have puffiness under the
18:40eyes but in all cases fat transfer comes
18:43together so that's kind of the trifecta
18:45of lower eyelid treatment is bringing
18:49all those different parts together when
18:51they are all involved together but not
18:53in every case there are sometimes it's
18:55just volume loss sometimes it's it's Fat
18:57Loss in addition to excess skin
18:59sometimes it's a combination of three as
19:01we just mentioned so those are our tools
19:04that are available to us in our toolbox
19:06what isn't in in my toolbox that you may
19:08have heard about is things like laser
19:10resurfacing to tightening skin or
19:12different energy devices not a fan of
19:14any of those if I want to remove skin
19:16I'm going to remove it directly under my
19:17vision and make sure that I get what I
19:19want out and make sure that I leave what
19:21I want behind and never to affect the
19:23quality of the skin because when one of
19:24the things that happened when people do
19:25deeper surfacing on the lower eyelid
19:27skin it's already thin to begin with and
19:30then when you do that type of treatment
19:31you end up causing extra thinning of
19:33that region which over time can become
19:35an issue so that my friends encompasses
19:39the understanding and treatment of the
19:43lower eyelid area so let's take a look
19:45at a few before and afters let's take a
19:47look carefully at these qualities so as
19:50you can see in this before photo and all
19:52the before photos you're going to see
19:54that the quality of volume loss exists
19:55hollowness under the eyes and and kind
19:58of a deepening Darkness under the eyes
20:00so that's number one you can see this
20:02very clearly number two you can see
20:05there is extra skin involved as well so
20:09when you see that extra skin you're like
20:10okay boom skin pinch out of the toolbox
20:13the other aspect that you can see in
20:15this particular before photo is the
20:17presence of fat pad now this puffiness
20:20under the eyes again pretty common
20:22scenario not ubiquitous but way skin and
20:25volume losses but it's pretty common
20:26this is what it looks like in all these
20:29cases you can see the eyelid cheek
20:31Junction is long right compared to what
20:33we showed earlier which showed what a
20:35young short lower eyelid cheek Junction
20:39looks like so now let's take a look at
20:41these before and afters what they look
20:42like is a refreshed bright looking eye
20:45without any evidence of surgery right
20:47shape looks the same the eyes overall
20:50look the same the essence looks the same
20:52Spirit looks like they just look less
20:53tired there's not the hollowness there's
20:55not the puffiness there's not the excess
20:58skin and as you review these before and
21:00afters pay close attention to that
21:02eyelid cheek Junction and you'll notice
21:04that before it was long and after it's a
21:07lot shorter and this is ultimately what
21:10a good before and after should look like
21:12it doesn't need to be perfectly filled
21:14that's not the criteria of a good
21:17outcome a lot of people mistake this
21:19because they're so used to using fillers
21:21to kind of fill to the hilt with this
21:23type of an issue that that's not where
21:24you want it to be you just want it to
21:26look a lot better A lot more fresh and a
21:28lot more youthful without looking
21:30different and that is a success welcome
21:33that's what we should be thinking about
21:34all right folks I hope this helped bring
21:38some light onto a very very interesting
21:41common and important topic because
21:44empowerment and understanding how to
21:46manage the aging process in all of its
21:48forms whether it's your skin whether
21:50it's your jawline and neck whether it's
21:51your eyes all of the stuff means a lot
21:54to us as individuals and we want to get
21:56it right and we want to make sure that
21:57we're doing the right things and I hope
21:59this gives you some understanding of the
22:01processes as well as the treatments and
22:03how to achieve that all right like
22:04always my friends if you enjoyed this
22:06hit like comment below if you have any
22:09questions subscribe if you haven't
22:10already and definitely send it along
22:12some friends and family we want to get
22:13the word out we want to help people find
22:15these messages in this simple fashion
22:17and simple form so that people can be in
22:20the driver's seat alright folks thanks
22:22again appreciate it until next time Dr
22:24Karen
22:30oh
22:35foreign

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This page contains the full transcript of BEST ways to treat Under-eye Aging by DrAmirKaram, generated from the public captions YouTube serves with the video. The transcript has 4,404 words across 621 segments, with the original timestamps preserved so you can click any line to jump to that moment in the embedded player.

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