ELLE
The Final Cut
With its reputation marred by a history of hollowed-out sockets and too-taut brows, the traditional eye job could be going extinct. Sarah Bernard reports
Julie, 36, a marketing executive, had had it with her deepening crow’s-feet and under-eye circles. They’d officially progressed from irritations to certifiable fixations, as had the deep grooves above her brow, which she blamed on “age and my mom.” Plenty of her friends had already embraced surgery—one girlfriend regularly traveled to a doctor in Brazil for “the works.” Julie’s virtually vacation-free job didn’t allow for the downtime a traditional eye job required, plus she was leery of the bony, unblinking look she’d seen on other women. So she’d resigned herself to an anti-aging plan that went something like this: “Nothing, or surgery when I’m 50?”
But on the last day of a business trip to New York City, Julie discovered plastic surgeon and eye specialist Stephen Bosniak, MD, who had an office in her hotel’s gym. With only a few hours before her flight home, she squeezed in a consultation. Rather than surgery, Bosniak suggested Botox; Julie opted for the injections right then and there. Every eight months she returns to Bosniak’s office for a cocktail of Botox, Restylane, and chemical peels, which, she insists, fills her furrows, lifts her brow, opens up her eyelids, and provides “overall tightening.”
Using injectables to treat the brow area is not a new phenomenon, but the growing backlash against traditional eye lifts—once the bread and butter of the plastic surgery industry—is. Since the eye area ages a full decade ahead of the rest of face, it comes under scrutiny first. Given that surgical procedures increased by 44 percent last year, according to the American Society of Aesthetic Plastic Surgery, one would expect eye lifts to have registered the largest spike. In fact, the eye lift is the only procedure in the top five that doesn't seem to be on an astral trajectory. Liposuction, for example, the most popular, shot up 24 percent, while eye lifts rose just 8 percent.
The ease and ubiquity of injectables is partially responsible. New York City dermatologist Dennis Gross, MD, the founder of MD Skincare and author of Your Future Face (Penguin), helps patients navigate the expanding menu of less-invasive options. Often he'll suggest mixing and matching multiple treatments such as a fillers, chemical peels, and Smoothbeam lasers to tighten the eye area. He notes that last year, 82 percent of plastic surgery procedures were noninvasive. But what’s really turning people away from the scalpel—more than the fair of anesthesia, the expense, and the extended recovery that come with an eye job—is the too-real potential of looking worse, permanently, after the surgery. One 44-year-old pharmacist (who asked us not to use her name) had been contemplating a lift to fix the "creepy wrinkly skin” under her eyes and die heavy droop of her upper lids. She’d been hesitating for two years because she feared she’d emerge post-op looking like “the scary ladies I see on the tennis court with pulled, hollowed eyes”, a look as dared as the fashions of Dallas or Dynasty.
The problem with the eye job, according to Lawrence Reed, MD, a New York City plastic surgeon and an assistant clinical professor at New York Presbyterian Hospital, is that the procedures standard protocol hasn’t changed: Cut out as much fat and skin as possible from the lid and under-eye areas, then stitch everything back up. “Everyone was proud to show how much fat they took out; its how we were trained”, Reed says. “But we were removing too much facial fat”, according to Reed, “is an extremely valuable commodity; its the plumpness under the eyebrow that makes people look young. Preserving the fat on the lower and upper lids and repositioning it, he explains, is the key to rejuvenating the eye area”. “You're trying to look your best at your age, not look 20 if you’re 40”, he says with a sigh. “People are slow to get this.” Reed now spends five hours a day, one patient per hour, doing lower lid “septal resets”: He dislodges the fat pads under the lower lash lines and moves them to plump the top of the orbital bones. “Its like moving a lamp on a table and keeping it plugged in. You bring it to the other side but leave it attached to the wire, which is the blood supply. Then you suture it in. This,” he says proudly “is the ultimate recycling.”
Zachary Gerut, MD, a Long Island, New York-based surgeon, has created a new technique for upper lids. “It started because my patients brought me pictures of their eyes when they were plumper and younger, and I said to myself, Well, how the heck am I going to do that?” he says. One of those patients was the pharmacist. When Gerut explained how he’d restore fullness in her upper eyelid area by isolating the fat that had slid between her eyebrows and her eyelid creases, rolling it up like a jelly roll and tacking it to a higher position on the bone, she decided finally to schedule a procedure.
“EVERYONE WAS PROUD TO SHOW HOW MUCH FAT THEY TOOK OUT; IT'S HOW WE WERE TRAINED”, SURGEON LARRY REED SAYS. "BUT WE WERE REMOVING TOO MUCH.”
For those with droopy lids, Gross notes, only surgery will do. No matter how skilled a doctor is with plumping repositioned fat or an injectable, he can’t erase excess flesh. However, eye lifts are too often prescribed to fix sagging brows, a problem they could never solve. For decades, the only brow-specific surgical option was a coronal brow lift, a gruesome, extremely invasive operation in which the entire forehead skin is separated from the muscle, then trimmed and reattached. Since most patients weren’t keen on essentially being scalped, their doctors would remove extra upper-eyelid skin instead. Inevitably, the brow would just drop further and the sagging skin would return. Some patients, after repeated attempts to rectify the problem with more skin removal, wouldn’t have enough left to close their eyes. “When you cut away the sagging skin of a 67-year-old who would die at 75, it wasn't an issue. But now you’re working on a 40-year-old who will live to be 80”, says Thomas Romo III, MD, the director of Facial Plastic Surgery at Lenox Hill Hospital in New York City. Instead of the drastic coronal lift or the shortsighted lid trim, Romo uses an endoscopic brow lift (requiring just four incisions) to raise foreheads by a few millimeters as well as to open up the eye area. Christie, a 35-year-old attorney, signed up. “I don’t look like a different person now. Its not like my eyebrows are up in my hairline”, she says. But there were major changes. When she went to a bar with friends a week after Romo’s lift, she was carded. “I showed the bouncer my license”, she says, “and he held it up to the guy next to him like, ‘1970, yeah, right!’”.
Not every new procedure is getting positive feedback. Threading, also known as a feather lift, is a controversial technique designed to tighten laxity around the eyes. Polypropylene sutures are laced through an incision near the scalp, then anchored in place by the upper cheek. When the strings are pulled back toward the hairline, tiny barbs grip the surrounding fat and “lift” the skin upward. David Hidalgo, MD, a Park Avenue plastic surgeon who specializes in face and breast procedures, spends an increasing amount of his time removing barbed threads that have loosened or, worse, left a patient with dimpled and puckered brows or crows-feet. “Its kind of symbolic of our time,” Hidalgo says. “Technology is hyped before its efficacy is proven. The FDA approves something as safe, then it moves from the manufacturing stage to the patient at extreme speed.”
As word gets out that quick fixes such as die feather lift have failed and that surgical techniques have become more in sync with the natural look patients want, the eye lift may be poised for a comeback. Reed hopes so but gives his patients all the credit for the turnaround. “This was not a master plan from the surgeons to switch what they were doing”, he says. “Women deserve a lot of praise for saying they want to look normal.”