When I ask patients what they would most like to aesthetically improve, four out of five mention their eye area. For some the target is crow’s feet, for others, bags or dark circles. Many don’t like drooping eyebrows and eyelid hooding that worsens as we age. Most people show much more aging around their eyes than in 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 as you repeatedly iron them. In addition, eyelid skin is some of the thinnest of the body, showing wear sooner than more resilient skin. The good news is that the area around the eyes can be easily improved with new techniques and technologies.

Under eye circles are a very individualized area where age, genetics and lifestyle all come into play. The muscle situated just below the eye is one of the darkest muscles on the body. Since it is under the thinnest skin on the body, the pigment of the muscle shows through, giving us dark, purplish undereye circles and making us look tired and old. For many this is exaggerated as as the skin loses collagen and becomes thinner and also by shadows created by bags and hollows beneath the eye.

Loss of fat and collagen can cause a hollow or valley, called the tear trough which extends from the inner corner of the eye down and out toward the cheekbone. This is genetic, but generally worsens with age. For the right patient, this can be beautifully corrected with filler. Although a great procedure, it is very important to seek out someone comfortable treating this area. Many fillers are not safe in this area, and treatments require specific knowledge and training.

Matthew’s eye area picture (in blog)

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 full correction in some, correction will require 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 medications which relax muscles like Botox or Xeomin, which can also be used to minimize bunching under the lower lash line (seen in some people who usually look “squinty” in pictures). Over time, softening the crows feet with botox helps prevent creasing that permanently etches 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 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, however, the surgery always leaves some degree of scar. It also only removes that portion of skin and does not improve the surrounding skin, only stretching it tighter.

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 lovely improvement. Treatments can be customized to achieve the individual’s goals within their downtime constraints.

If this all sounds complicated, it is. The aesthetics of the eyes involve a complex interplay of many 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. Schedule a consultation with Dr. Rebecca Gelber to learn your options for achieving your goals and then sit back and bat your lovely eyes at your admirers, knowing you look your best. Call 775-298-1750 or email office@tahoeastheticmedicine.com today.