The eyes see only what the mind is prepared to comprehend. And the mind creates what it receives through the light of perception.

The eyes… the most important part in the perception of the human face. Looking at one’s face, whether in person or on a photograph, we look immediately into the eyes for instant communication.  We’ve learned to manipulate the process of perception by numerous physical adjustments of contours, light, contrast and color, making our eyes a feature of beauty, thought and character.

Our perception is attracted somewhat negatively by a shadow and positively by light. The brighter areas stand out clearly and openly whereas shadows contract, hide and recess.

The eye is naturally framed by the anatomical structures of our skull. This frame, however, is not a stable feature. We can adjust it artificially using creative make-up, manipulating muscular structure with neurotoxins (such as Botox) or enhancing the area either by dermal fillers or surgery.

Over our lifetime the majority of changes occur naturally due to the passing of time and the aging process. This leads to the dilemma: what can or should be done in order to re-establish the youthful features of the eyes. This leads to questions: when to do it, how to do it and if to do it?

One would think that “plastic surgery” these days can correct any of these problems with ease and sophistication. But it is not always the case. Frequently, correcting one obvious problem uncovers more serious aesthetic abnormalities that could have been avoided by a clear understanding of the dynamics of visual perception.

Here is an example of two distinct pairs of eyes: a primate family member and a cat. Immediately, our perception discovers an attraction and attention directed toward the eyes of a cat; primate’s eyes diffuse and disappear in the wide shadows of the frame.

Compare the eye to a framed painting. If the frame is overwhelming with its proportion it distracts the attention from the focus of interest, the paining.

                                              

This is exactly what happens in our example from the animal kingdom:

Here, in the case of a primate, we see a wide frame created by the shadows; it eliminates distinction between the eye and its surroundings.

                                              

However, in this member of the cat family, the shadows are mostly non-existent and light is allowed to surround the main object of attention. The frame becomes an enhancement of the contour of the eye rather than a distraction and being very narrow our visual perception of the eye is undisturbed.

One of the most common aesthetic problems is “hollow eyes”, this is either related to the unavoidable natural aging process or it is a surgically-induced visual and anatomical distortion.

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This patient has many features related to aging that prompted her to have corrective surgery. Please pay attention to the upper part of her face including the “hollow eyes”- the empty and shadowed space between the upper eyelid and orbital rim, below the eyebrow.

Here is the same patient “after” the facelift surgery:

                                                    

At first glance, we see a significant improvement. However, on closer inspection it becomes obvious that the improvement is limited almost entirely to the lower face. Let’s take a look at both images, “before” and “after”, side by side with only the upper face to be examined:

There is no aesthetic improvement of the upper face except for decreased wrinkles. Unfortunately, the “hollow eyes”, the hallmark of aging, remains unchanged.

How can we improve this in a simple way?

Let’s simulate the “after” surgery look with a simple correction of the “hollow eyes.” In practice, this can be achieved by either surgical fat transfer or non-invasively with a skillful filler injection.

Here is the result of simulation:

There is an immediate aesthetic improvement after the disturbing shadows of hollowness were eliminated. It allows much more light to enter the area surrounding the eye.

Could we do even better aesthetically? We can continue the simulation and achieve further aesthetic improvement and still remain within the simple steps that do not require a surgical approach or an unrealistic, difficult procedure.

This time let’s change the position of the eyebrows. We will…lower them slightly!   

It is a common misconception that the aging eyebrows descend with time. Aesthetically it is the opposite; elevated brows are one of the aging features.

 

On the following image we lowered both eyebrows with a rather amazing and calming rejuvenating effect. This can be easily achieved with botulinum toxin (Botox):

Now, let’s go back to a full face image and compare the “after” face lift picture with our simulated improvements:

The simulated effect corrected the “hollow eyes", lowered the eyelids, eliminated the naso-labial folds and corrected the chin area.

Of note: these corrections in practice can be achieved without surgery.

                                                                   

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Finally, the images of the upper face “before” the facelift are placed next to the actual “after” surgery picture and compared to what could have been a better aesthetic outcome if the basics of visual perceptions were applied:

                                                 ACTUAL RESULTS

                                       before surgery                 after surgery

                                                    

                                             SIMULATED RESULTS

               

                                       before surgery         simulated after surgery

                                                  

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In this particular example the surgical face lift did not provide optimal results. A further correction is possible with the following options:

- the “hollow eyes” can be improved by enhancing the area immediately above the

      upper eyelid with either fat transfer or with dermal filler injections

- the position of the eyebrows can be changed by lowering with botulinum

toxin (Botox)

- the naso-labial folds and chin area can be easily corrected with dermal filler

The surgical facelift is a procedure that can achieve the most wonderful and long lasting results. It requires, however, not only superb technical skills but also an excellent understanding of light, visual  perception and interrelation between all parts of the face structures . Anything less than this could result in a disappointment.

Marek Kacki, MD

VISAGE MedArt