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The first step towards a more refreshed and youthful look – my step-by-step aesthetic assessment

The first step towards a more refreshed and youthful look – my step-by-step aesthetic assessment

Both women and men in their mid-50s to mid-60s want to have a more refreshed and youthful look, but don’t necessarily want to have aesthetic surgery. For this group, which often has very little time, there is an increasing menu of treatments available to help you to look refreshed and rejuvenated with minimal disruption to your busy lifestyles.

The aim of aesthetic non-surgical treatment around the eyes and face is to restore the youthful balance between the eyes and the rest of the face. First of all, you’ll require an aesthetic assessment. This is a half an hour consultation with myself (the oculoplastic surgeon here at Clinica London).

During the assessment, I listen to your concerns. Whilst we are chatting I am observing your face. I am looking at the quality of the skin, how the light reflects off your skin, whether there are any blemishes, redness, brown patches, crepiness, wrinkles, and sagging areas.

I look specifically at the areas you are concerned about and in this case we are talking about the area around the eyes, which is called the periorbital area.

I look at the forehead to see its length,

I judge the level of the eyebrows along with their shape,

I look at the shape of the bony orbit around the eyes,

I look at the shape of the cheeks, and determine whether there is cheek projection or whether the eyes are in front of the cheeks in which case that is called a negative vector of the cheeks to the eyes.

I look to see whether there are any bulgy lumps around the eyes that could be fat pads. These occur in the upper lids towards the nose and along the lower lid orbital rim and top of the cheek.

I look to see whether there are deep hollows. Deep hollows can be in the upper lid what is known as superior sulcus or in the lower lid when it is commonly known as tear trough hollowing or dark circles.

I look at the strength of the muscles around the eyes, which open and close them. I look at the way the eyes move and I also look at the eyelid margins and the tear film under magnification using the slit lamp.

I take photographs and formal measurements. In particular, I am interested in measuring the lengths on the upper lid and for that I will first of all measure the amount of vertical opening of each eye and then the amount that is open from a light reflex from the eye, which is called the upper margin reflex distance.

I measure the upper lid that shows, which is the part of the eyelid where you apply makeup.

I then ask the patient to look down and I measure the amount of upper lid skin that there is below the skin crease or skin fold.

I measure the entire length of skin between the upper lashes and the lower border of the eyebrow.

I look at the function of the eye on closing, whether it shoots up underneath the eyelid thus adding protection to the eye.

I look for asymmetries between the two sides.

I then go down to the lower lids and with my fingers,

  • feel the orbital rim the tear troughs,
  • the fatty bags,
  • the upper cheek establishing how much laxity there is and where exactly the bulges are, how much excess skin there is and whether there is any inherent eyelid laxity.
  • Again I look at asymmetry between the two sides.

We then discuss what type of non-surgical treatment that may be best for the patient. Surprisingly, many patients do not want Botox and some do not want filler so we provide them with alternatives for treatments around the eyes.


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