5 mins
The eyes have it
DR ANNE MENDELOVICI
Dr Anne Mendelovici has over 20 years’ experience in aesthetic and anti-ageing medicine and has been working between Paris and London for over 15 years. She is a well-respected, highly experienced doctor and one of the UK’s leading specialists in aesthetic treatments and injectables.
Aesthetic Medicine: What’s your aim when you treat a patient?
Dr Anne Mendelovici: I’ve been in medical aesthetics for a long time, and my philosophy is the natural look. Sometimes, less is more. I like to see someone first, and listen to what the patient wants, because you might see something, but the patient may look in the mirror and be focused on something else.
We are all like that, we all have dysmorphia about our own appearance. After I have listened to the patient, I give some advice. My main concern is to help them look fresher. We want them to look the best they can. For me, the perfect aesthetic is when I help my patient fight against the natural ageing of the face by reducing the appearance of wrinkles, restoring lost volume, reducing sagging of muscle and skin, as well as improving the skin texture.
Aesthetic Medicine: Which area of the face is best to treat to make a patient look fresher?
Dr Mendelovici: Each part of the face plays an important part and can make a patient’s face look tired, such as a heavy eyelid, a cheek that has lost volume, sagging cheeks or a dropping or smaller lip. For optimal results, it is best to treat the entire face, but as a doctor, I must also listen to my patients’ requests and concerns. An over-injected lip can have the opposite effect and make a patient look older.
If we take a closer look at the superior part of the face, patients mostly come and see me because they want to get rid of wrinkles in the glabella, forehead, or crow’s feet areas. To obtain a more rested look, what’s needed is to open the eyes.
Before any botulinum toxin injection, it is important pay attention to the shape of the eyes, the size of the forehead, any asymmetry in the eyebrows, and the heaviness of superior eyelids. It is only after a thorough analysis of the patient’s face that the practitioner can decide where to inject for best results.
If someone has a very heavy superior eyelid, botulinum toxin injections in the forehead will have to be very light and closer to the hairline, not too close to the eyebrows, to avoid an even more droopy eyelid. The muscle around the eyes (orbicularis oculi) is like a pump for lymphatic drainage. For patients who suffer with under eye oedema, it is recommended to avoid botulinum toxin injection too low in the crow’s feet area, as this may increase the oedema and result in a tired look.
Botulinum toxin injections are the perfect treatment to get a rested and fresher look. However, it must be well administered otherwise it can have the reverse effect. Each botulinum toxin treatment must be tailored to each patient’s face and features.
Aesthetic Medicine: Do you recommend thread lifts for eye treatments?
Dr Mendelovici: I’m not a fan because thread lifts can cause bruising and don’t last. If it’s a polydioxanone (PDO) thread, it will boost the collagen, but it won’t lift the eye. To achieve lift, you need to use a different type of thread, and it’s a little bit more invasive. You only want to do an eye lift if the superior eyebrow is too low, in which case sometimes you may need a surgical procedure, a superior blepharoplasty and sometimes a brow lift.
Aesthetic Medicine: What about tear trough filler?
Dr Mendelovici: We have changed the way we apply tear trough filler a lot. Previously, we used thicker hyaluronic acid (HA), which was not a good thing. Now, it’s lighter and more fluid (Redensity 2 from Teoxane, for instance). The problem with tear trough filler is sometimes it doesn’t age well. It can cause lymphatic drainage blockages, which can create swelling if not injected in the correct area and the product is not suitable. The filler can be dissolved, but the eye region is very sensitive, so that isn’t ideal. The other problem with HA filler is that it adds volume, which can make the eye look swollen and more closed.
Aesthetic Medicine: What other treatments would you consider for the eye area?
Dr Mendelovici: For very wrinkly inferior eyelids, it is necessary to be more invasive with the procedure. The fractional CO2 laser is a good indication for this. It is a treatment that should be done during winter as you will be required to avoid sun exposure for a couple of months post procedure.
For eyelids that are not too wrinkly, we can use treatments that boost collagen production and therefore increase skin elasticity reducing the appearance of wrinkles. This includes microneedling, platelet-rich plasma (PRP) and polynucleotide injections.
Aesthetic Medicine: What are your preferences for topical skincare to compliment treatments in the area?
Dr Mendelovici: When patients come to me for the first time, I talk about their skincare routine. I ask, ‘Where do you put your eye cream?’ Very often, they put it in the inferior eyelid, too close to the eyes, when really, they need to put it lower as it absorbs upwards. If they put it too close to the eye, it can block lymphatic drainage which can cause puffy eyes. It is also better to use a topical gel rather than a cream if you tend to get puffy eyes.
As you become older, particularly during the menopause, the under-eye skin becomes darker, thinner and drier. I recommend a vitamin C moisturiser in the morning to prevent pigmentation, and retinol at night for its anti-ageing effect, as retinol is known to help treat fine lines. I don’t have any specific brands to recommend for eye skincare; I would say it’s about finding the skincare products that work for you and your skin type.