Articles: Browse Category

The Eyes Have It

Dr John Kippen

Ageing can involve the structures of the upper face. Hair may thin and hairlines may recede, foreheads become more creased, often in an unequal pattern. Eyebrows can also drop. This may be compensated by lifting the eyebrows. An excess of skin, muscle and fat develop in the eyelids. Each part of the face and the contribution of each component, needs to be assessed when planning surgery. 

Receding and thinning hair needs to be considered when planning incisions and subsequent scars. Brow lifts can address receding hairlines using a carefully placed incision. Forehead wrinkling can be smoothed and the eyebrows lifted. This will also remove some skin from the upper eyelids. Traditional brow lifts involved long incisions across the top of the head, however, technique refinement has been towards limiting the incisions and potential complications. 

Endoscopic brow lifts using a camera and specialised instruments allows smaller incisions but the surgery to still be performed under vision. Temporal brow lifts are very effective in lifting the outer eyebrows and may be combined with either muscle relaxing injections or muscle resection to address the central eyebrows. A direct brow lift can be performed in an existing forehead wrinkle or just above the eyebrow thus concealing the scar.

Upper eyelids tend to develop an excess of skin especially laterally away from the nose. This is known as lateral hooding and an excess of muscle also develops. This is the circular muscle that runs around the eyelids not the lifting. Towards the nose side it is common to develop and small pocket of fatty tissue that may bulge. Eyelid surgery carefully addresses each of these components. 

At times the upper eyelid may become attenuated (stretched) or detached. This causes the eyelid itself to drop which is known as ptosis. At the time of surgery this can also be addressed either by tightening the muscle tendon or re-attaching it.

The tear producing gland may also droop and become visible. A tightening procedure needs to be carefully performed to minimise the risk to tear formation. With ageing the tear film components, watery, oily and mucous, change. This may predispose to dry eyes.

The frowning muscles, corrugator, can be weakened during the surgery by removing or resecting some of the muscle bulk.

Lower eyelids have retaining structures that hold the fatty tissue within pockets. These become weaker and may droop resulting in lower eyelid bulges. The position of the lower eyelid is critical. The upper border should be just at the position of the colour part of the eye. The eyelid needs to be in contact with the globe or eyeball so that the draining tear ducts are against the eye to allow tear drainage. Often the lower eyelid may need to be tightened or repositioned to maintain this relationship to the eyeball. The retaining structures are also tightened to support the fatty tissue. Less fatty tissue is removed and may be grafted back to decrease ridges. The retaining structures may be repositioned, also to obliterate the ridges. All surgery needs to be carefully planned. Choose your surgeon carefully making sure they are members of the Australian Society of Plastic Surgeons.

Dr Kippen is a practicing plastic, cosmetic and reconstructive surgeon and a member of the Australian Society of Plastic Surgeons. Dr Kippen consults from rooms in Mona Vale, Brookvale and Wahroonga. Phone 1300 547 736 or email 

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