• Don't smoke: By far, the most important preventative measure under your control in the prevention of overall eyelid deterioration is to not smoke. Smoking causes a sickly degeneration of not just the skin but also an increased laxity (stretchiness) of the eyelid support system. Any experienced eyelid surgeon can easily identify the skin of a smoker from its reaction to surgery alone. Such skin has increased and irregular vacularization, bleeds excessively, and has a "mushy" quality when held with forceps.
• Avoid excessive unprotected exposure to direct sunlight: "Photoaging" of the skin from the cumulative effects of ultraviolet light exposure is the main determinant of eyelid wrinkling and irregular pigmentation. Excessive UV exposure can also thicken skin to a leathery texture and cause actual structural stretching. The risks of developing skin cancers are markedly increased.
The most effective methods of protecting the eyelids from UV damage have little to do with advanced sunscreens or sunblocks (which can irritate the eyes once they melt and make their way into the tear film). While such preparations are highly desirable for use on the skin beyond that next to the tender eyes, the regular use of sunglasses, a visor, or a wide hat when spending time outdoors will better protect the eyelids.
The regular use of an eyelid moisturizer containing certain antioxidants (see below) may also offer some protection against photoaging.
By the way, sun tanning in moderation after blepharoplasty is not an issue since the incision on the upper eyelid is tucked into the depths of the crease and the incision on the lower lid is most commonly placed on its inside surface. Sun tanning after eyelid chemical peel, however, is very much a mistake, especially during the first two or three months after peeling when UV exposure may result in blotchy over-pigmentation.
• Skin moisturizers: Skin moisturizers come in almost countless versions with prices ranging from a few dollars to hundreds of dollars a bottle. What is most important in choosing an eyelid moisturizer is that you select a preparation formulated specifically for use next to the eyes. While moisturizers do help to "plump up" dry skin and blunt the appearance of wrinkles, it is hard to prove that there is an long-term permanent benefit from using commonly available eyelid moisturizers. Many women use such preparations with religious fervor, while most men never use them once in their lives.
• Special eye creams and gels: In recent years, a whole slew of new additive have begun appearing in eye creams designed to do more than merely moisturize (so called "cosmeceuticals" that blur the distinction between drugs and cosmetics). For instance,
• antioxidants such as Vitamin C, Vitamin E, co-enzyme Q, and lipoic acid are widely advertised to aid in the prevention of sun damage, suppress inflammation, and promote healing. In fact, there is little or no scientific justification for these bold pronouncements, which remain entirely unproven in real-life clinical situations (as opposed to what may happen inside of a biochemist's test-tube). Such fashionable antioxidants are, in the opinion of some respected research dermatologists, little more than "hope in a jar." In one controlled study, for instance, vitamin E actually worsened the appearance of scars in over 90% of patients.
• alpha-hydroxy acids (also known as "fruit acids" and glycolic acid, etc.) are said to help wrinkling by thickening the epidermis and dermis with new collagen and to improve skin luster by diminishing the abnormal build-up of keratin.
• Tretinoin: Retin-A and Renova (Ortho Pharmaceuticals), both prescription creams, initiate a number of effects ranging from elimination of keratin build-up to possibly increasing dermal collagen to increasing new blood vessel formation. Because tretinoin thins the outer layer of the skin, sun sensitivity may develep. While skin dryness and irritation are common, such preparations do seem to decrease wrinkling. Several newer preparations that may be less irritating are now available, including Retin-A Microcream and Differin (Galderma) gel. Tretinoins are usually applied at bedtime.
• Bleaching agents: A number of preparations based on hydroquinones do not remove pigment already there as much as they prevent the production of new brown pigment (melanin) that causes splotchy coloration and freckling.
• Natural remedies: Numerous botanical extracts are said to refresh the skin and include aloe, cucumber, green tea, chamomile, and others.
• Laser skin resurfacing and chemical peels are discussed in Chapter 22.
