When I ask patients what they would most like to change or improve, four out of five talk about their eye area. For some the target is the crow's feet, for others the bags or dark circles. Many don't like the drooping eyebrows and eyelid hooding that worsens as they age. Most people show much more aging around their eyes than the rest of their face. There are a number of reasons for this. Like the area around the mouth, the eye area is very mobile. We smile, blink, squint and widen our eyes hundreds of times every day. The skin is bunched, folded, stretched and creased over and over; this takes a toll, breaking down collagen fibers and etching lines into the skin, much the way a crease is worked into your pants if you iron them in the same place every day.
In addition, eyelids are made of the thinnest skin of the body, with little cushioning fat below. Areas where the skin is thinner, such as the eyes, the decolletage, and the backs of the hands are less resilient and show wear sooner and more prominently than other areas. The good news is that these areas can be easily improved with new techniques and technologies.
Under eye circles are a unique and very individual area where age, genetics and lifestyle all come to play. The orbicularis oculi muscle, situated just below the eye, is one of the darkest muscles on the body. Since it is overlain by the thinnest skin on the body, the pigment of the muscle can show through, giving us dark, purplish undereye circles and making us look tired and old. For many this is exaggerated by shadows created by bags and hollows beneath the eye.
Shadows can be caused by loss of fat and collagen in this area. This is genetic, but generally worsens as we age. This forms a valley, called the tear trough, which extends from the inner corner of the eye down and out toward the cheekbone. For the right patient, this can be beautifully corrected with filler. Although this is a great procedure, it is very important to seek out someone comfortable with treating this area. Many fillers are not safe or appropriate in this area, and the procedure itself requires specific knowledge and training.
For others, shadows in the undereye area are caused by a protruding bag of fat or skin. This cannot be corrected with filler. Laser skin resurfacing can improve in this problem by tightening the skin and increasing the skin's collagen and thickness, but for some, correction requires a surgical procedure, known as a blepharoplasty. This involves removal of excess fat and skin and again, should only be performed by an experienced surgeon - referrals are key here.
Patients are often troubled by their crow's feet. Improvement of this area is easily accomplished with Botox, which can also be used to minimize bunching under the lower lash line (seen in some people who always look "squinty" in pictures). Over time, softening the crows feet with botox helps prevent the creasing that etches permanent lines into this area. Botox can also be used to gently raise and balance assymetric eyebrows. Note that this is not the "Joker" or "Spock" look that frequently accompanies inexpertly Botoxed foreheads and frown lines.
Brows can be further enhanced with fat or filler, restoring an arch which often flattens or hollows out with age.
Finally, and perhaps most importantly is the quality of skin. This thin, fragile skin loses collagen early, resulting in a loose, crepey or sagging appearance. This can be surgically corrected by a blepharoplasty. However, the surgical removal of a wedge of skin will always result in a scar. It also only removes that portion of skin and does not improve the surrounding skin, only stretching it tighter. Still, for many with significant hooding, bags or redundant folds of skin, this may be a good option.
For those with moderate laxity, crepiness, or some etched in lines around the crow's feet area, newer laser techniques which ablate (remove) damaged skin and collagen fibers can offer a lovely improvement. This is usually done as a series of gentle fractional resurfacing procedures, each involving only a few days of mild redness and puffiness but which can smoothly remove 30% or more of the tissue in a very even distribution over the entire area without any scarring. For those who are looking for more dramatic results and only a single treatment, significant tightening and improvement can be obtained with advanced full-field resurfacing procedures, usually requiring 6-8 days for healing. Laser procedures also stimulate the deepest layers of the skin, causing increased collagen production and further improvement over the following months.
Finally, lashes matter. As we age, our lashes become thinner and form less of a frame for the eye. This can make eyes look smaller or more sunken. We associate full, healthy lashes with youth and beauty. Fortunately, for many Latisse offers a safe, FDA-approved treatment which takes only a few seconds each evening and offers dramatic improvement in not only length, but darkness and thickness of lashes. Many patients are afraid of Latisse because they have heard that it "will turn their blue eyes brown". This is an important risk which doctors should discuss with each patient to whom they prescribe Latisse, but is a hypothetical one which applies to those with hazel (not blue) eyes and has never been observed when treating the eyelash line.
If this all sounds complicated, it is. The aesthetics of the eyes involve a complex interplay of dozens of factors, each of which change with age and expression and are uniquely individual. An ideal solution for one may provide no benefit, or even harm to another. Sit down and discuss your concerns with your doctor, learn your options for achieving your goals and then sit back and bat your lovely eyes at your admirers, knowing you look your best.