The square-inch of skin under the eyes may be tiny, but it packs a punch. Sagging, darkness, wrinkles — there are a host of concerns that can show up in the under eyes, many of which worsen over time. “The skin located right beneath the eye is thinner than the rest of the skin on your face,” says Mariana Vergara, NP-C, an aesthetic nurse practitioner in Beverly Hills. “As we age, there is a loss of elasticity and collagen and the skin becomes even thinner.” Another issue? How much we use our eyes. “This area is constantly in motion, causing fine lines to appear,” she notes.
Due to the nature of the under eye area, it requires an approach different from the rest of your facial treatment routine. “The eyes are one of the features we are naturally drawn to when we look at someone’s face,” says Charles Pierce, MD, a double board certified plastic and reconstructive surgeon at Rowe Plastic Surgery. But, as he points out, under eye concerns aren’t a one-size-fits-all problem. “Each patient needs a proper evaluation of what will work for their needs,” Dr. Pierce says. “Under eye treatments are tailored to what the major problem is but almost always are approached with multiple modalities.”
So, what does the combination therapy entail? We asked the experts.
In-Office Under Eye Rejuvenation Treatments
When skincare (think: eye cream) alone is no longer doing the trick, patients often turn to invasive and non-invasive procedures to refresh the under eye area — and providers say that a multi-pronged approach can create the most youthful, energetic-looking appearance. Below are some of the most popular non-surgical under eye rejuvenation procedures:
The providers we consulted all suggest patients address the look of the skin and the quality of the skin separately. First and foremost, Dr. Pierce’s go-to treatment for the under eyes includes Botox®, which is “great to soften the exaggerated muscle or animation response.” From there, he adds on a chemical peel, microneedling, or laser session to tighten the skin and lighten pigmentation (a low key cause of dark circles).
Board certified oculofacial plastic and reconstructive surgeon David Isaacs, MD, has a similar approach at his Beverly Hills practice. “Peels and lasers will typically smooth out the wrinkles and tighten the skin,” he says, while Botox® will address fine lines. Together, these treatments target multiple problem areas and lead to a synergistic result.
2. Under Eye Filler
For patients whose under eye concerns involve dark circles as a result of hollow-like appearance, under eye filler can be performed alone or tacked onto other treatments. “Dermal fillers are used to restore the volume loss and improve the hollowness in these areas,” Vergara says. Dermal fillers not only fill the space under the eyes, they also stimulate collagen production. Long term that will plump and thicken the delicate skin.
3. Platelet-Rich Plasma (PRP)
You may be familiar with platelet-rich plasma (PRP) for facial rejuvenation, hair loss, and even sexual health, but did you know it can also be used under the eyes? Dr. Pierce says PRP “can really improve that tired look.” According to Vergara, the plasma can be injected alone or mixed into filler for improved results. The platelets release growth factors, she says, which “signal surrounding cells to repair damaged tissue and regenerate new tissue.” The result is stronger skin, smoothed wrinkles, and an overall refreshed look.
4. Radiofrequency (RF)
For patients with skin types that may not be suitable for laser treatments, radiofrequency (RF) — which uses energy to stimulate the skin — may be an alternative. Vergara, who likes the therapy for patients with darker skin, says RF can address “fine lines, wrinkles, and under-eye bags. “It stimulates collagen and elastin production in this area, improving skin quality,” she notes.
A Surgical Alternative...
While this piece has largely focused on the array of non-surgical treatment options that exist to rejuvenate the under eye area, surgery may prove to be the best and most effective option for certain patients. When needed, Dr. Isaacs addresses age-related under eye bags with a lower eyelid blepharoplasty. This procedure can tighten the muscle, eliminate excess skin, and reposition fat. “Many surgeons perform this procedure under general anesthesia, however, I perform this procedure with either oral or IV sedation,” Dr. Isaacs explains. The benefit? “There's no breathing tube, and there's less nausea after the procedure,” he says.
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