One of the most common concerns I hear is, “I look tired all the time”.
During the normal aging process, our faces age in 3 different ways:
- Topical changes in skin tone (sun spots, freckles, rosacea, etc) makes us look more aged.
- Despite the fact that we seem to gain fat everywhere we don’t want it, we lose normal healthy fat in our faces. Around the eyes, this loss of volume is most noticeable in our cheeks where it uncovers the junction of our lower eyelid and our cheek. Many times this appears as a depression and the normal periorbital fat that has always been present begins to “bulge” and cast a shadow, hence the appearance of “dark circles”. The degree to which the lower orbital rim can be seen varies amongst all patients, and the therefore the treatment must vary as well.
- Increased skin laxity due to loss of elasticity. The combination of increased laxity along with volume loss further accentuates “dark circles”, plays a role in the appearance of frown lines and crow’s feet and is also responsible for the descent of the cheek and the appearance of jowels.
All of these factors work together to give the appearance of fatigue and aging. Treatment for periorbital aging is a spectrum, where on one end, a good night sleep and some sunscreen is all that’s needed for prevention and the other end of the spectrum is surgical rejuvenation (Brow lift, blepharoplasty, fat grafting).
For everyone in between these extremes, we find that a good combination is:
- Skinceuticals A.G.E. eye complex – addresses topical changes and skin laxity by supporting production of glycosaminoglycans (GAG’s) which are part of the extracellular matrix and help to hold moisture (volume) in the skin and may help to hide capillaries that can further worsen dark circles.
- Restylane – Hyaluronic acid fillers are long lasting (though temporary) fillers that can help to smooth the transition from the lower eyelids into the cheek and minimize or hide the shadow created by normal lower lid fat. Filler is best used for people that have minimal to moderate tear trough depressions which is typically limited to the medial side of the eye (next to the nose). As more of the orbital rim is exposed from volume loss, facial fat grafting becomes the preferred option.
- Dysport – the ability to decrease certain muscle activity around the eyes allows fine skin lines around the eyes to fade. Though any neurotoxin (Dysport, Botox, Xeomin, Jeuveau) does not reverse skin laxity, it does do an excellent job of hiding the signs of changes in laxity. Dysport is an excellent way to address glabellar frown lines that give us a worried, tired appearance and crow’s feet that can also make the periorbital area look older.