Q: Dr. Eppley, I am 37-years-old, and I have some wrinkles under and around my eyes I would like to get rid of and not sure whether I should just do Botox or try and have surgery to remove them. I have attached some pictures for your review.
A: There are basically three treatments for aging eye issues, Botox, blepharoplasty surgery and skin resurfacing (chemical peels vs. lasers). Botox is the only treatment for wrinkles that occur outside the eyelid area. Blepharoplasty (eyelid) surgery is the only treatment that can remove excess skin and fat on the eyelids. Skin resurfacing using either chemical peels or fractional laser resurfacing can be used for fine wrinkles on and outside of the eyelids. Given the nature of aging around the eyes, many people need a combination of these approaches to get the best result, not to mention the need for maintenance therapies such as Botox injections, topical skin creams and the avoidance of smoking and extreme sun exposure.
What I see in your pictures is hooding of upper eyelid skin and a roll of skin underneath the lashline of the lower eyelid. These are definitely surgical issues. The short story is that you are likely in need of surgery for major improvement, but I would not use the term ‘remove’ when it comes to eyelid aging changes as that is not realistic. You need to think improvement.
Q: Dr. Eppley, I am going to get a breast augmentation next month. I am 23-years-old. My plastic surgeon never mentioned or suggested getting a mammogram before surgery. I have read that some plastic surgeons require it, while others do not. What is your recommendation?
A: Whether a mammogram is needed before breast augmentation has no uniform answer. Every plastic surgeon has a different perspective on this issue. My practice is to not get a mammogram under the age of 35 unless there is a family history of breast cancer or a history of breast problems such as cysts or fibromas. While breast cancer does rarely occur in younger patients, the statistical likelihood of a young patient having it is so low that I do not feel that the extra expense and radiation exposure justifies the effort. After age 35, I follow the recommendations of the American Cancer Society in regard to a baseline mammogram and subsequent studies. Some plastic surgeons routinuely demand mammograms regardless of age before breast augmentation, and this is a perfectly valid approach as well. You need to discuss this issue with your plastic surgeon and reach a mutually acceptable approach.