What is actually happening
Several changes converge around the eye, and they arrive at different rates. The skin of the upper lid is the thinnest on the body and loses elasticity early, so excess collects there first. The brow settles gradually downward, taking the upper lid with it. Below the eye, the support holding orbital fat in place weakens, so fat that was contained begins to bulge, and the junction between lid and cheek deepens into a shadow.
The eye is read as one unit, so a change in any part of it is attributed to the whole.
That is why the upper and lower lids are assessed together even when only one is treated. Correcting one and ignoring the other can leave the face looking uneven in a way that is hard to name and easy to see.
What is worth ruling out first
The distinction that matters most is whether the heaviness is coming from the lid or from the brow above it.
True upper lid excess means skin has accumulated on the lid itself, with the brow sitting where it always did. That is what an upper eyelid procedure addresses.
Brow descent produces the same heaviness by a different route: the brow has come down and is pressing the lid into a smaller space. Removing lid skin in that situation treats a consequence, and it can pull the brow lower still. That face wants the brow addressed, alone or alongside.
Volume and shadow below is a third pattern. Puffiness under the eye can be protruding fat, hollowing at the junction with the cheek, or both at once, and they look similar in a mirror while calling for different treatment.
There are also medical causes of a change around the eyes that are not aging and should be identified before anyone discusses surgery. That is part of what an examination is for.
What treats it
Results
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BeforeAfter
Individual results may vary. The photographs shown are of actual patients of Dr. Keni who have consented to their use.
Common questions
- Why do people keep asking if I am tired?
- The eyes are where faces are read first. Heaviness in the upper lid, a shadow below, or a brow that has settled lower all register as fatigue before anyone consciously identifies what changed.
- Is it my eyelids or my brow?
- This is the question the examination has to answer, and the two are easily confused. Skin removed from an upper lid that was heavy because the brow had descended treats the wrong structure, and can make the brow sit lower still.
- Are the upper and lower lids treated together?
- They are assessed together, as one aesthetic unit, because the eye reads them as one. Whether both are treated depends on what is actually contributing.
- Will this change how I look?
- The intent is that you look rested rather than altered. A good eyelid result is one where people notice you look well and cannot say why.
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