THE STORIES EYES CAN TELL

Eyelid bags and crow's feet, courtesy of Father Time! These overhanging lid tissues and heavy orbital lines can transform sparkling, youthful eyes into tired, dull, hooded ones. Their onset can be hastened by heredity, smoking and excessive sun exposure.

External treatments offer temporary relief, at best

External treatments offer temporary relief, at best. Tea bags, cucumber slices and ice packs are popular home remedies. Specially formulated creams and lotions are their commercial counter-parts. While skillfully applied cosmetics can cover lines and blend wrinkles, those heavy upper eyelid hoods, deep crow's feet and fully packed lower lid bags present substantial challenges.

A quick glance at the family album may suggest where we are heading

What can be done? For starters, our grandparents were right! Bonnets and wide-brimmed hats protected them not only from sun-provoked skin cancers, but from the sun-induced changes of aging as well. If fashion consciousness rules out broad- brimmed sun shielding, then sun screens are a must! Although heredity is beyond our control, a quick glance at the family album may suggest where we are heading and whether surgery is an option.

Laser eyelid surgery offers two new options:

• Removal of excess tissue by excision
• Smoothing of skin lines and wrinkles by resurfacing

Laser excision surgery is usually performed using a carbon dioxide (CO2) laser as a scalpel. High-energy, precisely focused laser light is delivered in a fine beam which cuts delicate eyelid tissue by vaporization. During vaporization, heat is produced which seals the small blood vessels and nerves next to the surgical wound. Because laser incisions are virtually bloodless, there is usually no post-operative "black eye." Swelling is minimized too, because lymphatic vessels are sealed. And pain is usually minimal because the procedure seals the nerves.

An incision in the upper lid is placed along the lid crease to hide the small sear. Laser surgery to remove "bags" from the lower lids is done from inside the lower lid, leaving no visible sear at all. The bags are actually excess orbital fat that has pushed forward. The bulges typically cast unflattering shadows, producing a tired, sad expression. In extreme eases, the lower lids may be so full that they obscure vision during reading.

After surgery on both upper and lower eyelids, most patients feel more comfortable wearing dark glasses in public for three to seven days. Normal activities can be resumed in just three to five days: a long weekend is normally adequate time for recuperation.

Resurfacing to soften lines and wrinkles is also performed with the CO2 laser, in this case with a pulsed laser beam. The laser actually vaporizes the outermost layer of the skin in a carefully controlled fashion. The pulse minimizes the spread of heat to adjacent tissues.

Pain is usually minimal

In this procedure, the tough, thick skin that heaps up next to the wrinkle to form a crow's foot is removed. The wrinkle line itself cannot be completely eliminated, because these lines are caused by the movement of underlying muscles, the very movements that give expression to our faces. But when the edges of a wrinkle are smoothed, the wrinkle has a softer, more youthful texture.

The same resurfacing techniques can be applied to lines in the skin of the lower eyelid, to forehead wrinkles and to lip creases. The technique is especially helpful in eliminating the fine vertical lines at the lip margin that cause lipstick to "feather."

After resurfacing, the postoperative appearance of the patient is similar to a deep sunburn. Crusting and some weeping may last three to five days. Once the outer surface of skin has been replaced with new epidermis, makeup can safely cover the healing process. Most patients choose to stay out of public during these early post-operative days.

All laser procedures are done under local anesthesia, on an outpatient basis. Post-operative care is usually limited to ice packs and bland ointments, with Tylenol™ controlling pain, if needed.