Jeffrey Kenkel, MD, FACS
1801 Inwood Road, 5th Floor
Dallas, TX 75390
(214) 645-3112
Specializing in Cosmetic Surgery
of the Face, Breast & Body
(214) 645-3112 Dallas, Texas

Zooming In: Outside of the Mask

Given the major changes we have experienced in our lives since March, we have all had to adapt in many different ways both professionally and personally.  It seems like we have two faces to present to the world these days.  We have our online or virtual face, largely seen at home with our family, and online for virtual meetings and discussions.  As we enter the “in person” world, this changes, and our the lower 2/3 of our face is covered by a mask.  Just as with any fashion changes we have seen rapid growth in the mask industry, allowing each of us to highlight our personality and appearance with a variety of individualized masks to complement our best appearance.


As a facial plastic surgeon in Dallas, I believe the patients who are the happiest following either surgical or office-based changes are driven by self-motivation to look their best. We love the phrase, “look as good as you feel,” which as I get older, I completely get!  While the desire to put one’s best face forward remains a personal decision, the current state we are in has resulted in a greater fixation on several areas outside of the mask:

  • Hair
  • Forehead
  • Brow position and symmetry
  • The eyes and eyelids

For the sake of this blog, I am going to assume that each of us has someone we trust to address our hair or in some cases, the lack of thereof. 

Here are five things you can do to help address the other areas existing outside of the mask.

Give your skin some attention!

 

1) Don’t forget about your skin! – While a good portion of your skin is hidden behind the mask, the forehead and eyelids can be impacted by chronic sun exposure and the aging process and should be addressed. I am a firm believer in skin care and often suggest to our patients that there are 5 things they should consider beyond the age of 35:

  5 things to consider for aging skin care:

  • Sunblock – Skin care begins here. If you cannot commit to sunblock daily, all year long then there is no point in going any further.  If you live in an area that sees the sun, you are at risk for its impact on your skin, no matter what the temperature is outside. The best blocks are zinc or titanium oxide. The micronized versions are clear and have no residual color.  The outdoor or waterproof ones may leave you with a background white appearance. Look for an SPF of 30 or greater.
  • Cleanser – Choose a cleanser that is right for your skin: dry, oily, or neutral. Vogue offers some good tips for skin care and makeup for mask wearers.
  • Retin-A (or other vitamin A derivatives) – One of the most studied anti-aging agents we have today. Again, matched to your skin type, it will help turn over the outer layers of your skin and build collagen in your skin.
  • Antioxidant – Helps protect your skin from UV rays
  • Skin Lightener – Many of us experience pigmentary changes with chronic sun exposure and aging. This, often in combination with peels and lasers allow us to make the skin more uniform in color. Remember, sunspots make us look older.

there are several options for forehead lines!

 

2) Lines on our forehead – Over time we all get some lines on our forehead. We usually divide these into two types of lines, each having its own treatment:

  • DYNAMIC – These are lines we see when we lift our brows or animate. As you can see in our before-and-after photos, these types of lines can be apparent not only in the forehead but also between our brows (11’s). Patients describe these as lines that “make me look old” or “give me the appearance I am angry.”  These types of lines respond best to botulinum toxin (Botox, Dysport,  Zeomin, Jeuveau).  These products decrease the movement of the muscles in the area, which leads to fewer lines in these areas.
  • STATIC – These lines are there whether we are animating or not. They can come from long term “muscle” movement or simply be part of the aging process. While botulinum toxin may help, these often need either  dermal fillers to plump them out or an aggressive skin treatment like laser skin resurfacing or deep, microneedling session. Often, we choose combination treatment methods to get the best possible result. This may involve a toxin, filler, and skin treatment.

eyebrows can be more symmetrical with injections!

 

3) Brow position and shape – I think we all appreciate that we are far from perfect. We have asymmetries throughout our bodies, making us “human.” The brows are no different. Most of us have a brow that is a bit lower or different in shape than the other side. While brow grooming may allow us to achieve a slightly different shape, there are limitations. Our knowledge of anatomy enables us to understand the forces that are acting on the brow: elevators and depressors. We can use this knowledge and botulinum toxin to help shape the brow, elevating them and even creating a bit more symmetry.


upper and lower eyelids can look younger with several treatment options!

 

4) Upper eyelids – As we age, many things can happen to our upper eyelids:

  • They can become heavier, and in some cases, the skin can hang down, even over our eyelashes. This can give us a tired appearance and even impair our vision. Upper blepharoplasty is a term we use to describe the procedure that helps remove this skin to open our eyes up. This is an office procedure that can be done under a local anesthetic. One does experience some swelling and possibly mild bruising. The sutures come out around a week’s time, and activities can return to normal by 10 to 14 days.
  • In some patients, the opposite can occur. As we get older, there are some patients that become more, hollow in the upper eyelids. This can be due to a number of things including, weight loss, excessive surgery, or a genetic predisposition. We can restore this volume (volume is a sign of youth!) with either a filler product or fat. These tend to last a longer time in this area and allow these patients to have a more youthful appearance.
  • Finally, we can see an “opening of the eyes” with botulinum toxin when used in certain areas. Patients often enjoy this effect as much the erasure of lines.

    real patient case 33

    real patient case 285


5) Lower eyelids – Just on the perimeter of our mask, their aging can even be accentuated by a “fitted” mask. Three things can be impacted by the aging process:

  • SKIN – As we get older, the skin can become more, wrinkly and have sunspots or blood vessels present.
  • FAT – With time, the layers that hold the fat in around our eyes become weaker, creating the bags we see under our eyes.
  • MUSCLE – In some patients, the stretching out of the muscle around the eyes can lead to further bagginess and disharmony.

We have many options to treat the lower lids outside of eyelid surgery.  These include botulinum toxin, filler, and skin treatments. These are all individualized depending on what your goals are. As stated above, some patients will require more than one modality to achieve their desired result.


We are all concerned about safety today, and you can read about our COVID-19 safety measures in our related blog post. With the pandemic, we have to do our part by wearing our masks and practicing social distancing. We have tried to highlight some of the things each of us can do to accentuate the area of our face “outside of the mask.”


Thinking about injections or lasers? Both of our offices are offering 15% off your injections and laser treatments!  Or, are you more interested in longer-lasting procedures such as eyelid surgery in Dallas? Call us at the office at (214) 645-2353 or request a consultation.

 

 

 

 

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