Val Lambros m.d., f.a.c.s.

cosmetic and reconstructive surgery


Fascinating things happen to eyes as the face ages.

As people get older their eyes look smaller. By "eyes," I mean the lid aperture, the space between the eyelids containing the pupil and the white of the eye. This is universal as far as I can tell. Just spend some time looking at newscasters on TV or your relatives’ old photos, and it will become obvious. They get smaller for three reasons: One is that the lower lid border rises with age (a surprising finding of the 3D averaging). The lid also shortens from lateral to medial. There is a tendon called the lateral canthal tendon that stretches just a little, making the eye look shorter.

There is also a tiny bit of droop of the upper lid. I am convinced that this little droop is the main reason consults ALL say that they look tired.

There is a visible border between the lids and the cheeks. This border doesn’t seem to drop much though it becomes much more obvious.

Some faces lose volume around the eyes. Some gain. Interestingly, the eyes that people have when they are young — full long eyes — become less desirable as people age. People remember young eyes that they never had.

Here is a woman seen in her early 20’s and in her late 60’s. Look how full the young eyes are. As the eyes get older they get hollower, rounder, and look less long from side to side. There is more room for makeup, but you almost never see this kind of eye in a young person. Many people think they had eyes like those on the right when they were young. Wrong. They are old eyes. You can’t make this old eye look like a young eye unless you fill it in.

Look at how the eyes seem to get smaller with age. The actual size of the eyel doesn’t change, rather it’s the amount of eye that is covered by eyelid. There is some evidence that the eyeball recedes into the orbit as well. From 19 years old to 85.


When you put a camera in someone’s face they almost always lift up their eyebrows. If perfectly relaxed, most brows drop with age, though some stay the same place.

Here is another image of a woman at 30-years old and at 70. She had a rhinoplasty just after the younger picture. This is the thinning pattern of aging. She lifts up her brows since I am pointing a camera at her.


The eyes seem to get smaller, which comes from the eyelids. You can see them encroaching on the eye in every direction. Look at the border between the lid and the cheek: it stays in the same place, but gets much more prominent. Thre is no way to make upper lids eyes like this look better surgically, they need to be filled in to make them look better (look at the section on fillers).

Some eyelids and orbits deflate with age, some don’t. You can’t treat all people the same.

Look at the arc that the upper lid makes in people. In old people that shape is symmetric, like an ellipse, or the arc peaks toward the lateral part of the eyelid. In young people, that arc is not symmetric like an ellipse. It is truly almond shaped. This is easier to show than to describe. Look at the following images:

Look at the eye shapes in members of this family: a 10-year old, a 12-year old, and their mother. Look at the almond shape of the young eyelid aperture, see how it becomes more elliptical with increasing age. This is not universal, but it is very common.

This is yours truly at the age of 10 and 57. (Cute, huh?) I made the images the same size, and the change in shape of the eyelid aperture is quite obvious. This is a true almond eye. You can’t do it with makeup.