Wrinkles under and around the eyes inspire people to spend a lot of money on solutions from miracle creams to medically based procedures. The specific reasons for different types of wrinkles determine how the wrinkles are treated. I’ll discuss how I help my patients who come in concerned about fine lines and wrinkles under and around the eyes.
Many people first recognize signs of aging around their eyes. This includes wrinkles just below the eyes, to crow’s feet that appear when smiling or squinting. We face people every day with our eyes, and the eyes are the first thing we see in the mirror. The appearance of your eyes can project an impression to another person in a fraction of a second that you’re tired (even if you’re not), or older than you are. So, it’s natural to want to refresh the appearance of your eyes and diminish the signs of aging and tired-looking eyes.
Types of Wrinkles
There are two basic types of wrinkles around the eyes: static wrinkles which appear when the face is at rest, or with no expression; and dynamic wrinkles which appear when smiling or other facial expressions. Treating these two different types of wrinkles need separate approaches.
Wrinkles are one of the most noticeable aspects of an aged appearance. While there are more significant causes of facial aging such as loss of facial volume from bone loss, and sagging as skin and underlying support get weak, wrinkles are what most people see when they look at themselves, then conclude that they are aging.
There is a common misconception that under eye wrinkles are caused by excess eyelid skin. Patients will sit in front of me and pull on their lower eyelid skin and believe there is excess. In actuality, this stretchy characteristic is more the result of a decrease in skin quality and facial volume loss. Nonetheless, well-meaning doctors often try to address under-eye wrinkles during lower eyelid surgery by removing the skin. In my opinion, this is not the best treatment for wrinkles under the eyes, as skin shortage can pull the eyelids down, making the eyes look rounded and hollow.
What Causes Wrinkles Under Eyes?
Under eye wrinkles are most commonly caused by collagen loss, not excess skin quantity, so treatment should be about improving the eyelid skin rather than removing it. Lines that appear around the eyes with facial movement expressions, such as those commonly known as crow’s feet, appear due to muscle activity causing creasing. Collagen loss and breakdown, as well as constant creasing of the skin make these lines appear prominently, even at rest. Since movement causes these lines to deepen, limiting movement can help diminish these lines.
Best Procedures for Under Eye Wrinkles
Wrinkles under the eyes are treated by improving lower eyelid skin quality. This may involve heating devices such as lasers or radiofrequency technology applied with precision to stimulate the body’s collagen production. The body produces collagen as a response to injury, so applying heat, as well as removing part of the upper layers of skin as in the case of ablation are instances of controlled injury.
Increased collagen in the lower eyelid skin makes the skin thicker, and healthier. In addition, removal of the top layer of skin cells, allows new and fresh layers of skin cells to emerge. It is important that heating and ablative devices are not overused as too much heat energy, or overaggressive ablation can cause the skin to become thinner.
Collagen stimulation is not limited to the application of thermal energy and laser devices. Collagen production, and increased blood supply in the lower eyelid skin can be stimulated with a regenerative treatment called platelet-rich plasma, or PRP. Platelet-rich plasma is a concentration of the platelet component of the blood, which is responsible for healing when you have a cut. PRP also contains concentrated wound healing growth factors that can also stimulate collagen and stimulate blood supply to the under eye skin. PRP can also be used to help with skin discoloration under the eyes commonly known as dark circles.
To reduce wrinkles around the eyes that appear with movement, the treatment approach would be to reduce the movement that causes these wrinkles. This movement can be reduced by limiting muscle activity with a neurotoxin such as Botox, Dysport, or Xeomin as reduced movement makes the lines appear less deep. An artistic and experienced touch with injectable neurotoxins is important so that natural movement and facial expressions are not affected. With time and regular treatment, lines, and depressions in the skin caused by constant muscle contraction improve.
It is important to understand that wrinkles around the eyes cannot be eliminated. The goal here is to improve or reduce wrinkles. As is often seen in some well-known people, attempting to completely erase lines and wrinkles could result in frozen, expressionless faces that don’t look natural.
Laser and radiofrequency patients may take a day to a week before returning to work. The healing process which goes on below the surface is characterized by continued collagen production and remodeling. PRP can be placed below the skin as well as in the upper layers of skin, and can have anywhere from no downtime to a day or two. Neurotoxins like Botox and Dysport take about 3 days for initial effects, and 2 weeks for their full effect. It is routine for our patients to go back to work right after neurotoxin treatment.
When it comes to lines and wrinkles under and around the eyes, I always discuss aspects of lifestyle with my patients. Simply said, anything that’s not good for your health is not good for your skin. Poor diet, smoking, excess sun exposure, and indoor tanning with ultraviolet light accelerated the loss of collagen. I also discuss strategies for keeping the skin looking good for the long-term through regularly scheduled treatments and skin care products such as sunblock, eye cream and other skincare routines. In the modern world, people are constantly bombarded by irresponsible messaging from the internet and television. Hype for products and procedures result all too often in people having poor outcomes, and permanent skin damage. A lot of people make the mistake of having procedures based on coupon offers to save money or from inexperienced practitioners, only to spend more money and time trying to repair their overtreated or damaged skin. I recommend finding a doctor who you can trust to have your best interest in mind, and be your guide to navigate through all the messaging before you undergo a procedure. In my practice, I provide my patients with a treatment plan with an understanding of what to expect with the procedures I’ve recommended.