While some may argue whether "the eyes are the window to the soul," few would argue their enormous aesthetic importance to our overall appearance. In Western culture, unlike some Far Eastern societies, we relate to each other by looking first into the other person's eyes. The familiar expression, "seeing eye to eye," attests to the significance of relating to one another through our eyes.

For this reason, whatever improvements we make in the aesthetic appearance of our eyes carries a disproportionate benefit, a total effect that goes above and beyond the mere improvement of the eye areas. In other words, just by making the areas surrounding them healthier-looking, more attractive, and more youthful, we are taking a long stride in the direction of rejuvenating our entire face.

With the passage of time, the eye unit, which comprises the upper eyelids, lower lids, and eyebrows, suffers from a number of different aesthetic problems that result from chronic sun damage, genetics, gravitational changes, improper nutrition, smoking, and alcohol or substance abuse. In an article on non-surgical facelifts, I describe how over the decades, the heart-shaped pad of fat that sits squarely over the cheekbone in youth shrivels and slides slowly down off the cheek and heads inward toward the nose, leading to accentuation of the smile lines and "parentheses" lines around the sides of the nose and on the lower cheeks, and the sad lines surrounding the mouth and chin.

But the sinking fat pads may also give rise to profound effects in the appearance of the lower eyelid region. When they are in their proper place, the plump fatty tissue serves to physically intercede between the surface of the skin and the dark-colored blood vessels located below. So when they shrink and move downward, dark circles appear under the eyes.

When robust and present, they also buoy up the skin above and stretch it tightly. With their loss, the skin of the lower lid may become grainy and sunken-looking, and “tear troughs” may begin to appear. The tear trough (what doctors call the nasal-jugal groove) is a fanciful description for the channel-like region located between uppermost portion of the cheek and the bottommost section of the lower lid.

Having lost much of its youthful elasticity, the skin under the eyes fails to redrape itself smoothly and tightly. Instead, like a balloon that has lost all its air after a long period of inflation, the skin there may appear wrinkled and crinkly, like crepe paper. To make matters worse, an age-related weakening of the tiny, strap-like muscles located directly under the eyes may allow small amounts of the fat deposits that are normally hidden below them to herniate (stick out), giving rise to what doctors call "festooning," or, in lay language, bulging below the eyes. Dark, "panda-eye" circles, puffiness of the lower lid, crepe-like quality, wrinkles, and "tear troughs" are the unhappy result of all the above changes.

Fortunately, a combination of Botox Cosmetic and an appropriate volumizer, a volume replacement material, can significantly improve each of these problems. Two tiny drops of Botox instilled directly into the baggy tissue below the eyelids has been demonstrated in many cases to diminish or soften the wrinkling and crepe-like quality. Using a technique bearing the cumbersome name of suborbital augmentation, the tear trough deformity as well as the sunken area immediately above it may be inflated with Radiesse (Juvederm Ultra Plus or Perlane can also be used).  Suborbital augmentation not only can raise the trough (the depressed area itself) but is also capable of compressing the crinkly area just above it (the region immediately under the eye) to diminish wrinkles and the crepe-like quality and level out any bulges. At the same time, by revolumizing the entire area, the blood vessels located below once again become much less visible through the surface, diminishing the appearance of dark circles.

Not being immune to the aging process, the upper eyelids suffer their own problems. Excessive or redundant (sagging) skin on the upper lid, known as dermatochalasis, can not only be an aesthetic liability, but when severe can actually interfere with vision. In most cases, however, it just makes the eyes look hooded and tired.

The position of the eyebrows is another casualty of father time. In young women, the inner half of the eyebrow lays directly over the rim of the bony orbit. Two-thirds of the way across in the direction of the temples, the brows flare upward above the brow line buttressed by an outwardly projecting mound of fat. When this fatty tissue shrivels and flattens with age, the outer brows sink to level of the rim of the orbit or even below it. The now downwardly directed outer third resembles the shape of the normal male brow and imparts a sterner look to the female countenance.

To remedy these changes, Botox Cosmetic may used for what has been called a "chemical brow lift."  To weaken the downward traction of the muscles in this area that is in part responsible for the fallen eyebrow, Botox is injected directly under the outermost segment of the hairs of the eyebrows. By, in essence, giving an advantage to the upwardly pulling counterparts of the treated muscles, the sagging outer brow is lifted back up to its original position ABOVE the bony rim of the orbit. Finally, the volumizers, Juvederm UltraPlus and Perlane, each have been used successfully to both restore youthful fullness directly below the outer brow and complement the effects of the Botox. Consistently gratifying results (for both patient and doctor) in restoring the eyelids and brows (as well as cheeks, jowls, noses and lips) using these materials and techniques have led some cosmetic dermatologists to refer to these treatments by the acronym RAVE, which stands for Regional, Aesthetic, Volume Enhancement.

The accompanying images demonstrates non-surgical rejuvenation both of the lower and upper eyelids and eyebrows. In the "after" shot, which was taken immediately following treatment, note that the trough is no longer visible below the eye. In addition, the brow has been lifted sufficiently to diminish sagging, to give more “show” to the upper lid, and to reproduce the youthful flare of the outer brow. Consequently, the eye appears wider.

Fees for lower lids and brows generally range between $750 and $1500 each. Lids and brows together usually takes no more than ten minutes to treat, and the results may last from eight to twelve months before a touch-up may be needed.