The eye is the aesthetic center of the face. Many women and men spend a lot of time and resources on ways to rejuvenate this delicate area. Not only is the eyelid skin the thinnest on the body, but it tends to show signs of aging early because of constant muscle contraction beneath, exposure to UV light, and a paucity of elastin and collagen compared to other skin areas of the body.
There are many ways to tackle rejuvenation of the periocular region. The first method is the use of topicals: both eye creams and eyelash enhancers. In October I wrote an article that you can refer to discussing various eye creams. Regarding the lashes, it has been clinically shown through data from the Allergan trials that our lashes age as we age. They get shorter, thinner and lighter. As well, the lashes play a key role in the aesthetics of the eye area. Latisse is the only FDA approved product to treat hypotrichosis. It is used nightly at the base of the lases for 4 months and the results are a 25% increase in length, 18% increase in darkness and a doubling of the fullness of the lashes.
Botulinum toxins and dermal fillers can also be used to shape the eyes. Botulinum toxin to the forehead, glabella and crows feet we are all familiar with. Care must be taken in the frontalis, as too much product can flatten the brow and result in an unhappy patient. It is best to inject conservative amounts in the area, stay above midline and combine this injection with a glabellar injection, which will provide a net lift to the medial brow. The toxins can also be used in the lateral brow for a ‘chemical brow lift’ providing a subtle 1 to 2mm lift of the temporal brow. When injected into the pretarsal orbicularis, you can flatten this muscle in those with hypertrophy. Dermal filler can also be used to shape the eyes. The most popular area to inject around the eyes is in the tear trough. Since the skin is so thin in this area, there is not a lot of room for error. My advice is to use a hyaluronic acid so that if the result is not optimal, hyaluronidase can be used to dissolve the material. These products can be combined with botulinum toxins to treat the glabella, crow’s feet and lateral brow. It is ideal to wait at least 1 to 2 weeks after the botulinum toxin injection for maximal effect before injecting the filler. Injection into the glabellar lines must be done with care. Stay superficial so as not to compress or occlude the neurovascular bundle which can lead to necrosis.
The last non-surgical rejuvenation technique is laser resurfacing. Both ablative and non-ablative lasers can be used in this area to thicken the skin, reduce dark circles, visible incisions, scars and wrinkles. With the updated fractional systems, usually a series of treatments are required.
In summary, a combination of the above technologies is optimal for treating the periorbital region. Each addresses a different aspect of aging around the eyes.