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Part 2: Eyes And Lids

The eyes and their surrounding structures are the most complex and expressive parts of the face. The eyes are quite literally an extension of the brain and can convey a myriad of feelings without any additional expression from another part of our physical being. Many people consider their eyes their best feature. When they feel that way, they are in fact thinking of the entire "orbital" area, meaning the brows, the upper lids and the lower lids in addition to the actual eyes themselves. We talked about maximizing the beauty of your brows in my last note on "contrast", and now we'll talk about the eyes. Bringing out the beauty of your eyes really refers to making the most of the lids and brows. Not everybody needs or wants eye make-up, but most of us benefit from it, especially as we age.

natural eye makeupAlmost all women look more beautiful if the eyes stand out as a feature. Unfortunately, as we age the eyes themselves tend to sink back and down a bit as the openings in our skull -- in this case the eye sockets, or "orbits" -- enlarge with the inevitable loss of bone. (Our skulls shrink about 20% over the course of our lifetime.) Additionally, the eyelid margins which form a sort of hammock between the bone at the sides of our nose and our temples tend to be stretch and the eyes appear smaller horizontally and rounder. This latter condition can be corrected surgically, but a bit of receding back of the eyes is something we just have to accept. However, the "appearance" of the eye being smaller can be helped with some well-placed cosmetics.

While it may seem intuitive that placing a darker color around the eye will make it recede more, remember that contrast makes an object stand out against its background, and therefore appear more prominent. This was one of the first things I learned during my training as a professional artist. So if we can create that contrast without placing a shadow in areas that will visually push the eyes or lids back, we've created a more beautiful eye. There is tremendous variation in color, prominence, shape and tilt of the eyes and lids. Making up the eyes in a manner that suits each individual's face, personality and lifestyle often requires some help from experts, and we are here if you need us at 941.951.2220. That said, defining the eyelid margins with eyeliner creates the contrast that makes the eyes stand out from the rest of the face. There are different forms of eyeliner including liquid, gel, wet and dry powders and pencils. Pencils are the easiest to master. There are myriads of colors, but the most universally flattering are either brown-blacks for warm-toned complexions, cool gray- or blue-blacks for cooler complexions, pure blacks or smokey violets, the latter of which were discovered by the Impressionist artists of the late 1800's to be a natural "shadow color" in nature.

Although there's a little learning curve with liner, once you've mastered it, it's pretty easy to do. Here again, some professional lessons can be immensely helpful. The two mistakes I see with eyeliner the most are too harsh a line, and a line that ends at the outer corner of the eye. In the first case, a strongly defined line can look great on some people, but it can look too harsh on most of us. Pencils are particularly good at creating a defined line at the base of the lashes where you want it, but they easily can be softened at the opposite edge and blended into the surrounding skin or shadow. Because the eye appears to narrow as we age due to the lid margins weakening, a more youthful shape will always be achieved by bringing the liner beyond the outer corner of the eye a few millimeters. By lifting the line up and out a bit at the outer corner of the upper lid and then connecting the line to the outer edge of the lower lid margin -- forming a "V" that is sort of on its side but lifted a bit -- you can help recreate the almond shape more associated with youth.

Next time, we'll talk about contrast and your lips.

How to Make Your Face Look Instantly Younger With Contrast

Part 1: Cheeks and Brows

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In previous entries with this title, we covered attitude -- because your outer beauty is a reflection of your inner beauty.  Now here's something that can be dealt with in a minute and an issue I see with women on a consistent basis.  One of the quickest and easiest ways to make your face look healthier (and therefore younger) is with contrast.  A monochromatic face is much more likely to look tired than a face with contrasts of light and dark and contrasts of color.  Given that we all know that you never want to take any of this to extremes, contrast immediately provides a lift to the face, so here are a couple tips:

1. My newer patients often will come in having used an allover bronzer (we are, after all, in Florida down here) to give the face a bit of tan.  That's fine.  A little bronzer can warm up a face really nicely.  But if you're going to use it all over the face, you then need to give yourself a flush of color on the apples of the cheeks.  Better yet, you can put a touch of that color across the bridge of your nose and the tip of your chin to mimic the flush of a young person who's just come in from a good run.  Bronzer placed evenly over the face without a pop of color at the cheeks can look flat or even muddy.  Another thing you can try is simply using the bronzer where you would put a blusher and leaving the rest of the face its natural color.  Remember though, that subconsciously the observer will read a bit of pink at the cheeks as good blood circulation.  Good circulation indicates health and the look of health is appealing to an observer.  If you're going to make a choice between only bronzer or only blusher, almost always the blusher will give a healthier look than bronzer alone.

2.  As we age, our eyebrows tend to become thinner and lighter in color.  Since it's a gradual process, our eye adjusts to it so it looks normal to us, and sometimes we continue to pluck until there's not much left but a thin line.  One of the indicators of youth is a full brow with good color, again within reason.  Most of us (who are female) can't carry off a really heavy brow.  But a full healthy one looks so much younger -- and healthier -- than a skinny line.  Generally, brunettes and deep redheads require a brow color slightly lighter in value than their hair color.  Blondes and lighter redheads should go with a color that is slightly darker than their hair color.  A pale or disappearing brow is to your eyes like a house without a roof.  Brows frame the eyes and direct the observer's eyes to yours.  When you first change the brows, it may take you a little while to adjust to the new look, but almost inevitably a full healthy brow with good color contrast against the skin is going to make you look more attractive.

As always, you're welcome to call us for an evaluation at 941.951.2220.  Jill, our aesthetician (who looks like a fresh little meadow maid herself -- and amazingly young) can show you exactly what to do using our good-for-you and absolutely beautiful Jane Iredale cosmetics.  Stay tuned.  In the next blog we'll go over this topic as it applies to your eyes and then later we'll talk about your lips.

Friday, 01 November 2013 14:34

Are you afraid of aging? | Attitude Part 2

aging-processThere is a growing number of quantum physicists who theorize that thoughts actually may have mass, and there are corollaries called "field theory" and "morphogenic fields" postulating that thoughts may have a physical effect on us and our world.  Additionally, there is a striking collection of experiments and anecdotal reports that support these theories.  What can we take away from that in our talk about aging?  We can at least suspect that a positive attitude, treating others the way we would want others to treat us, an outlook of cooperation rather than competition, and well-developed senses of compassion and empathy may very well contribute to our own well-being.  Indeed, I have seen over and over throughout the past two decades of my career that people who are kind, honest and concerned as much about the well-being of others as themselves seem to stay younger in body and mind versus people who "have an edge".  There's a lightness and a centeredness about them that surely contributes to that perception of youth and vitality.  

There is a rich cornucopia of books out there on these subjects to suit every personality and taste.  Gregg Braden's "The Divine Matrix" is a great place to start.  A former aerospace computer systems designer, his writing never proselytizes but presents the reader with a feast of ideas to contemplate regarding just who we are.    

An excellent way to bring your mind to a peaceful place is to meditate.  My patients have sometimes said, "Oh, I can't do that -- my mind just starts to race".  It's difficult for us, especially in our modern culture (although even Tibetan monks can have the problem) to completely quiet our minds.  Know that you don't need to do anything formal like sitting in a particular position and you certainly don't need to reach a "goal".  Sitting quietly for a few minutes and focusing on just listening to yourself breathe can be immensely calming.  "Meditation" can even be losing yourself in a beautiful piece of music or stroking a beloved pet while appreciating what animals can teach us about unconditional love.  Perhaps remembering an incident in your life when you felt particularly whole or fulfilled is a good way for you to begin.  Anything that calms you or makes you feel peacefully happy, even if it's just for a few minutes here and there, is therapeutic.  

Neurophysiologists have demonstrated that our brains have an amazing amount of "neuroplasticity" -- that we can continue to develop our brains throughout our lifetime.  If you want absolute proof, log on to Lumosity.com and start training.  It's very inexpensive, a lot of fun and you can track your progress with each session.  

Aging is part of living; it's what we do because we are living.  Attitude is one of the few elements of our lives over which we have control.  Choose to see aging as the gift of living another day or another year.  Choose to see aging as an opportunity to continue to grow rather than as a decline.  The body you live in is precious.  Give it the exercise it craves (certainly under a physician's care if you have any health issues) and the nutrients that make it healthy.  Give your mind the benefit of healthy stimulation and your soul the elixir of a positive attitude.  If it takes some discipline, that discipline will reward you many times over.  Now that that's all solved, we'll talk later about having a face that reflects how vital and alive you feel!

Did you miss part 1? Click here!

Thursday, 17 October 2013 16:01

Are you afraid of aging? | Attitude Part 1

o-AGINGMy father always said that getting older is much better than the alternative. To rephrase the sentiment, when my patients bemoan their advancing age (and this often starts in their thirties) I tell them that we all have a turn at being a particular age -- unless we don't, which is not a terrific option. One of my favorite axioms is from a good friend who opined that "old" is always 15 years older than your present age. Since my patients range in age from their mid-twenties to their mid-nineties, I can attest to the truth of that.

What most people are really concerned about are all the associations we have with aging, and usually that would be a slow decline into feebleness and drooling insensibility. The good news is that our whole paradigm around that picture has changed radically over the past few decades. There has been a shift even in the past 10 or 15 years. As I've often advised my patients, anyone who is a toddler right now may very well grow up thinking grandmothers can be a blast to spend time with -- not to mention, really hot-looking. I surely have a bunch of those in my practice and they are an inspiration to us all!

Here in Sarasota where people more often than not come to have a ball rather than to fade away as they get older, we have a perfect observatory for examining what is at work in aging fabulously versus not so fabulously. Let's start to take a look.


This is not a Pollyanna-ish thing, but acknowledging its importance is absolutely fundamental. On a physiologic level, things work a bit like this: If you routinely see the glass as half empty, not only are the endorphins ("happy" peptides that are secreted in the brain) not being secreted, but there's something else going on as well. Negative thoughts actually can place the body in a state of inflammation. This in turn causes aging of the cells in the body. Life is full of stressors for all of us. This can be anything from a careless remark that hurts to an entire range of family problems, a health issue or someone trying to destroy our life and/or our career. Remember that there are always things over which we have no control. We certainly have no control over what other people do. What we absolutely do have control over is how we respond to it. And this is where we have to be completely honest with ourselves and decide what that response is going to be. Given a perfectly normal period of anger or hurt, ultimately we have a choice between crawling under the bed and sucking our thumb, being mad at the world or dusting ourselves off and moving forward. Moving forward generally involves either attempting to rectify the situation or accepting it. Books are written on this, professionals are trained to help people with it and there is always at least someone who will be on your side. But ultimately, it's just really your call.

I remember during a particularly devastating time in my own life (I'm writing a book about it), I decided to take stock of it all. I bought one of those little journals with the blank pages. It had a muted pink linen cover with a beautiful botanical drawing on the front. This was to be my "grateful book". I began listing all the things for which I was grateful, even though I was feeling crushed by life at the time. Each entry was numbered: 1.I have a 3-digit IQ 2.I have the use of both arms 3.I have the use of both legs 4. There is a ceiling over my head 5.It is attached to a ceiling over a kitchen 6.In which there is a refrigerator 7.With food in it….You get the picture. Before I knew it, there were over a hundred items on that list. I just made it an exercise to review that list every morning. I pass this on because it was immensely helpful and so healing that it compelled one friend to say, "You're just like one of those Bozo the Clown toys. You get punched and then just pop up again." "Gee, Bozo the Clown," I replied, "I haven't had a compliment like that from a man in ages!"

That exercise was difficult at the time, but it was good medicine. More later.

Thursday, 26 September 2013 13:31


eyes women-300x225As we age, our eyebrows often tend to rotate down and in a bit at their outer ends. They also may thin and start to turn gray just like the hair on our heads does. The process is so insidious that we often don’t realize what is happening and that our brows may be part of the reason we suddenly notice that we look “tired”. Here are just a few tips on keeping a youthful brow. Know that I’m speaking in generalities since every individual is unique.

One of the hallmarks of a youthful brow is contrast between the color of the brow and the skin. While we want to keep our look as soft as possible as we age (since Father Time wants us to look harder and even angry), the whole upper third of the face will look prettier if the brows are well-defined. They truly are a frame for your eyes. The conventional wisdom is that we should keep the brows close to or a bit lighter than the hair color. If your hair is very light brown, blonde or gray, this rule does not apply. If the brows look faded, try a slightly darker shade of brow color. Give yourself a good day for your eye to adjust to the new color as the immediate change may throw off your perception of how it really looks.

If the brows are thicker, they will generally look younger. Pull out an old photograph of yourself and see if your brows are thinner than they used to be. If so, thicken them up a bit with your brow color, and again give yourself some time for your eye to adjust before nixing the result.

Ideally, the outer ends of your brows should be at the top of your brow bone, not curving down over the most prominent part of the rim. If the outer ends are lower than the inner ends, try lifting your brow color toward the topmost brow hairs laterally to improve the balance.

Also ideally, the outermost tip of your brow should be along a line that extends from the nostril through the outer corner of your eye on each side. Hold a pencil along that line and see where it falls when it reaches your brow. Since the ends of the brow tend to thin as we age, they can actually look shorter than the best proportion for you if you don’t extend it a bit.

Whether it’s just a matter of improving your brows with cosmetics or a situation that may require my help, we are just a phone call away if you need me or my wonderful aesthetician, Jill.

face-creamIn Part I, we covered your best topical products for intercepting the aging of your skin, “AA (anti-aging) creams” notwithstanding. However, there are now “BB (originally blemish balm, then later beauty balm) creams” and “CC (color correcting) creams” that multitask so you don’t have to layer on multiple products.

The term “Beauty Balm” covers a lot of territory, doesn’t it? Technically, we could affix this moniker to just about anything out there, otherwise why would we even bother using it? (Quite frankly, when my face breaks out, the most efficient “beauty balm” I could use would be a thick paste of benzoyl peroxide and a paper bag over my head.) Nevertheless, the conventional wisdom is that a “BB cream” is a product that combines sun protection with some foundation-like coverage.

The difference between a BB cream and a tinted moisturizer with SPF is that the BB cream generally offers more coverage and more sun protection. You want to look for an SPF of at least 20 for a normal business day with minimal sun exposure. Also, since SPF refers only to the UVB rays (the ones that can burn the skin), you also want to have a product that includes UVA ray protection (those are the insidious rays that come through windows, for instance, and don’t burn or tan you, but just quietly destroy your skin). These will either specify “UVA protection” or be labeled “broad spectrum” sun protection. We carry Jane Iredale products because they are anti-inflammatory, eco-friendly, cruelty-free, pure and really effective at making people look wonderful. Her new BB cream, “Glow Time” is just as fabulous as we would have expected with an SPF of 25, UVA protection and coverage that goes from light to concealer-quality, depending on how it’s applied. And as for the original “B”, this mineral-based cream won’t break you out or make you greasy either.

CC creams generally have a slightly lighter texture than BB creams. They contain various ingredients that benefit the skin and will usually have some sun protection. They distinguish themselves by being “color correcting” in that they will have a tint to offset unwanted skin tones. For instance, peach tones generally even the skin and brighten it up if it’s looking dull (too little sleep, anyone?), green or yellow will tone down ruddy skin and lilac will brighten sallow skin. Some CC creams will have a bronzing effect to warm us up a bit. Jane Iredale has a great one, except it’s been around for about eight years, doing what CC creams do without the catchy title. It’s called Dream Tint and comes in Peach, Lilac and Warm Bronze.

There are even DD and EE creams out there. Personally, I can’t wait till the marketing gurus get up to QQ. That could be a literary challenge. And by the time they get to XX, we may not even be able to talk about it!



What is the most direct route to facial beauty? The answer to that absolutely would be healthy and vibrant skin, hands down. We have lights and lasers, radiofrequency and ultrasound, peels and masks galore, but my patients always want to know what is the one best everyday thing they can slap on their faces to ensure the most benefit to their skin. While the one best topical product would be sunscreen (now don’t roll your eyes just because you’ve heard that ten thousand times – it’s true!), there is pretty much a consensus among those of us who devote our careers to faces that some incarnation of a “retinoid” (the original was Retin-A) is right up there next to sunscreen for preservation of your skin’s vitality.

What is so great about retinoids? First of all, they rev up the turnover of skin, so the outer (essentially dead) layer of cells that can make us look opaque and pasty thins out while the deeper layers become thicker and more springy due to the stimulation of collagen. They also act as an anti-inflammatory and break up some of the stickiness of the cells that plug up our pores. The net result is that after about four weeks or so of regular use, the skin starts to look more plump, clear and luminous. With consistent use of a retinoid over time the skin tends to age more slowly, as studies have shown and as I’ve seen in patients who have used a retinoid for decades. PS – It’s never too late to start. Just remember that because of the more rapid exfoliation of the top layer, you’ll be more sensitive to the sun, so always use a good broad-spectrum sunscreen and reapply at least every hour or two.

The most common reason I hear for people not using a retinoid is that it makes them red and flakey. Other people will tell me that they use one every once in a while on a wrinkle or a blemish. While some formulations are so strong that they are best used for spot treatments, the anti-aging benefits of the retinoids are seen with consistent use over the entire face (with the exception of the upper lids). Retin-A was developed about 45 years ago and we’ve come a long way since then in offering formulations for just about everyone. Your physician or aesthetician can help you find the right one for your particular skin.

Also remember that most skins need to build up a tolerance to a retinoid. We advise our patients to start using one every third night for about two weeks, every other night for two weeks and then nightly. To help your already overburdened brain keep track, start on a date that’s divisible by 3, like the 9th or the 21st; later go to evens or odds. At the end of any month with an odd number of days, anything goes! If you already have a good retinoid that’s still too strong, you can dilute the concentration with a little moisturizer or serum.


sparse-eyebrowBy now, with those little taxicab yellow smiley faces having become iconic, we’ve all had a chance to see how changing the position of the eyebrows on an otherwise bland round face with dots and dashes for features can have a powerful effect on the emotion that face conveys.  (If you use an Emoticon app on your cell phone or tablet, you know how you communicate more effectively with these faces attached to the text.)

The eyebrows are important.  They’re important for you and the look and mood you present to our vision-oriented world.  Standards of beauty change over the decades and right now a lower brow is considered more of the moment, but part of that may be a reaction to the over-arched, over-lifted, “surprised” brows that we’ve come to associate with a “surgical” look.  Also, while low brows on a tired appearing face can make one look more tired, low brows on a fresh appearing face just tend to look sultry -- and we have so many ways to keep a face looking fresh nowadays!  Injectables like BoTox, Dysport and Xeomin -- and fillers too -- can tailor the position of the brows a bit – and “a bit” can make a big difference in your appearance.  All that aside, a healthy, natural looking brow that sits in a position that is most harmonious with your individual facial shape will be the ideal for you. 

This is where I’ve seen the problem come in.  Many of us get so used to looking at ourselves, and the changes that take place over time can be so insidious, that we may lose sight of those changes and how much they affect the mood we project.

Let me share with you a few easily correctable problems that I see again and again in my practice. 

  1. It is not uncommon for the brows to take a little dip at the upper border just a few millimeters before the end that is near your nose.  This can create an artificially angry look and is corrected by filling in that dip with a bit of brow color.  Irrespective of the general shape of your brows, you want the upper border of your brows to have a smooth, gentle curve without dips or points.  Smoothing that contour out has an immediate softening effect on the face and can be easily done with short soft strokes of your brow pencil (or cream or powder),
  2. As we age, the brows can become thinner and horizontally shorter.  A full, healthy brow is both softer and younger looking.  However, our eyes may adjust over the years to the thinner, shorter brow.  If your brows are thin, try creating a fuller brow with your brow color – and give yourself some time to adjust to the new look before deciding that it’s too heavy.  Remember, they don’t need to be darker, just fuller.  Always use short, feathery strokes rather than a hard line.  We don’t want them to look pasted on.
  3. Hold a pencil at the side of your nose and tilt it so it grazes the outer corner of your eye.  Although there are minor variations depending on facial shape, generally the ideal ending point for the tail of the brow will fall where that pencil hits your brow bone.  A lot of women stop their brows short of this point and that can indeed be aging.  Also, keep the tail of the brow lifted if you can, not so that it wings out, but so that it falls more on the top of the brow bone rather than on the lower side where the brow can look “sad”.  If the brow hairs at the tail are rotating downward so that your pencil can’t correct it without looking as though you have two brow tails, you may want a little more help and we can talk.

I hope this was helpful.  As always, if you would like some assistance, give us a call and make an appointment with our wonderful aesthetician, Jill or with me.                


It’s been well over a decade now that we’ve come to appreciate the major role that volume loss plays in the appearance of facial aging. But prior to that, the best institutions, the textbooks and the journals were still teaching us that excess fat in the lids was a major culprit and that it needed to be rather enthusiastically removed. Aside from the foundational understanding that we tailor each procedure to the individual and that at least some minor amount of fat removal is a part of many upper and lower lid blepharoplasties, we are a lot smarter now than in decades past about preserving volume around the eyes and lids.

So the short answer to your question is “Yes”. However, we have certainly evolved in our techniques so that should no longer be an issue. Know however, that just having birthdays causes our eyes to sink somewhat. As I’ve discussed (probably ad nauseam to most of my patients), our skulls shrink significantly over time and we can see from imaging reconstructions that the body of the skull gets smaller and all the holes -- that would include the orbits (eye sockets) – get bigger. And that’s part of the reason why our eyes tend to sink back and down, even without any help from an old-fashioned blepharoplasty.

On the other hand, the “sags and bags” of aging lids can make us look and even feel tired or sad; and a well-done blepharoplasty can wake up the entire face and be immensely life-affirming.

Monday, 18 February 2013 15:12


Almost every week, a new patient will say something to the effect of, “I want to look better, but I’m so afraid of looking ‘worked-on’”. While there are unfortunate examples of what I call “The Look” all around us, it’s important to know that the sort of overdone, vaguely alien appearance that most of us want to avoid never ever needs to happen. Nor do we need to sacrifice a significant improvement for a natural appearance. We can have the best of both worlds -- really.

It goes without saying that extensive training in the head, eyes/eyelids and neck is imperative for a physician who is going to perform any eyelid, facelift or filler procedures. Additionally, aside from performing the procedures well, the physician needs to make an even more basic assessment of just which procedures need to be performed! As basic as that sounds, there are, for instance, facelifts done when the skin is wrinkled and volume has been lost from the face. In these cases, the lift may be OK technically, but the patient still looks tired, weathered or even a bit flattened out. In other cases, fillers may be given as a “lift” when the problem is gravity and a real lift needs to be done.

Fortunately in many cases revision procedures can be done to correct suboptimal results, although they may need to be “staged”, that is, done over time. In some cases involving fillers, I’ve just seen the patient periodically until a poorly placed or overdone filler starts to wear off. Then we start “tweaking” until eventually the effect is what we want.

The most beautiful and natural looking results require the physician to have a distinct talent, an “eye” for beauty. This, like any artistic talent, is inborn and includes, but goes beyond, technical expertise and training. But when your “work” is done well, it won’t look done; you’ll just look great and people will say things like, “You look wonderful! Did you change your hair?”

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dr barbour

Oculofacial Plastic Surgeon,
Sarasota, Florida

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