Aging Eyes: Unfiltered

by Julie Davenport, RN, CANS

Does anyone else secretly desire to use the most basic Snapchat filter for all of your photos?  There’s no doubt, the selfie movement has made us even more aware of our aging selves.  Snapchat found a way to correct and glamorize one of the most age-revealing parts of our bodies: the eyes.  Bigger.  Brighter.  Perfectly smooth.  Wrinkle free.  Who doesn’t want that?

Back to filter-free reality, we know that aging is inevitable.  However, did we know that it would bother us THIS MUCH?  As an injector, I hear a very similar story from most of my patients regarding their eyes.  It goes like this… 

Everyone thinks I’m tired.

I won’t leave the house without wearing concealer.

There’s no amount of eye makeup that makes me look rested.

As we age, there are several processes going on under the surface of the skin.  For starters, our bodies slow the production of collagen and elastin.  These are the building blocks for young, taut, smooth skin.  In addition, the fat pads that give our face fullness and structure start to fall - think continental drift plus gravity.  In its early stages, aging skin appears a little looser.  In its later stages, aging skin looks saggy and eventually crepey.  Lastly, bone loss is occurring, too.  Group all of these activities with genetics, and you’ve got your aging face.  Since we’re focusing on the eyes in this discussion, here are some common symptoms of periorbital aging skin:

  • Droopy eye lids
  • Etched lines - especially around the crow's feet
  • Hollowness below the eyes
  • Darkness below the eyes

Now that you are totally excited to continue with the aging process, know that there are in-office treatments that can be performed to address the concerns around the eyes.

Droopy Eye Lids

Dr. Clifton performs an in-office procedure to address excess eyelid skin.  It’s called blepharoplasty (or “bleph” for short).  Using a laser, Dr. Clifton removes excess skin and stitches the new lid back together.  The laser approach allows the patient to have a much quicker recovery time - not to mention, a less messy procedure!  The laser cauterizes blood vessels as it cuts away the extra skin.  Check out her results here.

Lines & Wrinkles

Back to my wheelhouse, injectable treatments are ideal for addressing lines and wrinkles around the eyes.  The most common concern is the crow's feet.  How do those little lines get there in the first place?  Well, it starts by being human and actually having emotions and expressions.  As we smile and squint, we make the same expression with our eyes.  Over time, that movement breaks down the collagen in that area more rapidly and leaves visible lines.  The fix: Botox!  Neurotoxins (such as Botox) relax muscles.  If the muscles around your eyes are relaxed, guess who’s not making expression lines (or wrinkles)?!  The pro about neurotoxins: they work!  The con about neurotoxins: the result only lasts about 3-4 months.  The most common side effect (besides never wanting to be without it) is injection site bruising or swelling.   

Hollowness & Darkness Below the Eyes

Dark circles.  No one likes these.  No one.  Let’s go back to that topic of bone loss.  In particular to eye aging, periorbital bone loss is a fancy way of saying that the skeletal holes where your eyes rest are getting larger over time.  Couple this with drifting fat pads and less collagen/elastin, you can probably understand why the under-eye area appears dark and hollow.  My favorite treatment for correcting this volume loss is injecting hyaluronic acid (or “HA”) based gel fillers.  I like HA fillers for a few reasons: (1) HA is naturally occurring in the body, (2) HA fillers are reversible if the desired result is not achieved, and (3) HA fillers are produced in varying strengths (or thicknesses) which allows me to customize a filler treatment.  Filling the volume-depleted area with an HA filler bridges the gap between the cheekbones and lower eyelids resulting in a continuous cheek.  Here's a look at some of my most recent under eye filler patients.

VL eyefiller

I treated this patient's crow's feet with Botox and used a hearty HA filler for her tear troughs (under eye area).  Her result simply says "rested" to me.  Without overfilling her face, we were able to give her a natural look.

PBo eyefiller

This patient's result is one of my absolute favorites.  When I see this before and after, I immediately notice her beautiful blue eyes!  By treating her glabella (area between the brows) with Botox, her "11's" are relaxed, smoothed out, and subtly lifted.  I injected a mid-weight HA filler in her crow's feet.  Since there were some deeper lines around the eyes, I opted for filler instead of Botox.  The most impressive part of her transformation is under her eyes.  I used the same HA filler as in her crow's feet in her tear troughs.   Not only does this patient look rested, but she also looks much more youthful after this easy, fifteen-minute, in-office procedure.

PB eyefiller

Here's another beautiful patient that wanted to look refreshed.  A goal of mine was to correct volume loss below her eyes and give her an overall softer look.  I injected Botox between her brows and strategically around the edges of her eyebrows.  The result is a more relaxed browline - lifted between the brows and relaxed around the arches of her brows.  Adding an HA filler below her eyes gave her the "wow-factor."   

KP eyefillerKP eyefiller2

It's no secret - when we smile, our eyes smile, too.  In the top set, the patient has a natural, pleasant expression.  In the bottom set, she is smiling.  I injected Botox in between her brows and in her crow's feet.  I placed a thick HA filler under her eyes.  What I love about her results is that whether resting or smiling, she looks appropriately youthful!  The Botox eliminated her crow's feet and the filler moves very naturally with her expressions.  A common misconception is that filler will appear lumpy and bumpy.  When receiving treatment from an experienced injector, that should never be the case!  Resting, smiling, laughing...your filler should complement your expressions, not restrict or distort them.  I adore her final photo.  Her eyes seem very happy, too.

AE eyefiller

Well, hello, bright eyes!  This is a great example of how HA fillers are a game-changer for the tear troughs.  A little bit of Botox to the crow’s feet and between the brows, some HA filler under the eyes, and bada bing bada boom you’ve got a youthful glow all over again!  The part of this story that you don’t see is her day-to-day ritual.  Makeup and concealer aren’t hiding her eyes, they are now enhancing them.

JS eyefiller2

This already youthful patient was seeing the early signs of aging in her tear troughs.  I cannot stress this enough: start earlier than later!  “An ounce of prevention is worth a pound of cure,” right?  With a minimal amount of product, we were able to replace the lost volume under her eyes.  The main contributing factor to her “dark circles” was actually lighting.  Often times dark circles are just shadows, not pigment issues.  When we fill the hollow region, the shadow goes away.  I also injected Botox in the same areas as mentioned previously - crow’s feet and glabella.  I love the effects of Botox on this patient!  Her brows have a beautiful, even shape.

About HA Fillers for Tear Troughs

The pro: they look beautiful and results last for 12-18 months (depending on the specific product used).  The con: assuming you are in good hands, I really can’t think of one!  One of the most common questions we get asked at Premier is,

“Does it hurt?” 

It is a very tolerable procedure for most patients.  For areas that are a bit more sensitive, we always offer topical numbing.  All of the HA fillers we use also contain lidocaine.  As the treatment progresses, the product itself is numbing the area for your comfort.  The second most common question is,

“How much downtime will I have?” 

As with any injectable treatment, bruising is always a risk.  The other side effect is swelling which usually subsides in about 72 hours.  We suggest giving the filler about 2-3 weeks to fully integrate with the tissue.  At that point, we schedule a follow-up appointment to see if additional product is needed or not.  The third most common question is, “Do I need to do anything to prepare for filler?”  Yes:

“Do I need to do anything to prepare for filler?”

Yes:

  • Stop taking blood thinners 2 weeks prior to receiving treatment.
  • Do not schedule any dental appointments in the 2 weeks leading up to your treatment or the 2 weeks after treatment.
  • Arrive at your appointment with clean skin.  If you’re wearing makeup, we’ll remove it.  
  • After your treatment, wait 2 days before exercising (walking is allowed, no running or lifting).

As with any cosmetic procedure, a consultation is the best starting point.  I encourage patients to schedule a complimentary visit.  During that time, we can assess your skin, hear your concerns/goals, and develop the best plan for your skin.  That’s right - it’s customized.