By Emil Shakov, MD, FACS

Why not make them glow?

Too often, signs of aging and fatigue can spoil beautiful features. Due to the COVID-19 pandemic and the need to wear masks, the eyes are the most prominent feature of our face.

Hooded or loose skin over the eyelids, hollows around the eyes, wrinkles and fine lines, dark circles under the eyes, and herniated fat under the eyes can all make you look old and tired. What causes these problems and what can you do about them without surgery?

Upper eyelids with hood

Dermatochalase is the appearance of excess skin over the upper eyelid that can cause a hooded appearance. This can be due to aging, which can lead to a decrease in eyebrow height, loss of skin elasticity, weakening of the connective tissue that hovers the skin over the eye, and the effects of gravity. If it's hard enough, the excess skin can block your vision.

Blepharoplasty is a procedure that removes excess skin over the eyelids to correct this problem. However, many patients do not want to go under the knife and do not want to bear the costs of such a procedure. Fortunately, there are alternatives to surgery that can contract the skin over the eyes.

One treatment that works well is microneedling (MN) using radio frequency (RF) energy. The procedure is quick and, if done correctly, can be relatively painless. It works by piercing many small needles through the skin and then delivering RF energy. The MN stimulates collagen production, which strengthens the skin in the treatment area. The RF will tighten the skin and stimulate collagen production. After treatment, swelling and redness may occur, which usually improve within a few days. Depending on the amount of loose skin you have, you may need to go through several treatments.

PDOthreadlift of the eyebrows can achieve a simultaneous eyebrow lift while lifting the loose skin. The sutures are inserted under the skin with a cannula. The sutures then anchor themselves to the deep layers of the skin with unidirectional barbs. When the thread is withdrawn, they create an instant lift. I usually recommend putting neurotoxin like Botox, Jeuveau, or Dysport on the forehead to minimize movement while the threads scar in place. Results can have a lasting effect for up to two years.

A more aggressive treatment can be carried out with a CO2 laser. The laser is ablative, which means that it creates a wound on the skin that causes it to peel off. The laser also penetrates the deeper layers of the skin, which causes collagen stimulation. Laser treatments can have prolonged downtime, leaving you red and puffy for up to a week or more. One treatment may not be enough to achieve the desired effect.

Hollow out around the eyes

Loss of volume around the eyes can cause your eyes to appear "sunken" and appear around the entire eye or in isolated areas such as a tear pit in the lower or upper part of the eye. It can lead to thin-looking skin around the eyes, dark circles, shadows around the eyes, and a tired look. Aging, weight loss, genetics, lack of sleep, and dehydration are some of the causes.

One of the most common methods of improving and restoring volume is dermal filler augmentation. Dermal fillers like Versa, Juvederm, and Restylane can be injected in and around the eye to restore a more youthful look. The procedure is relatively quick, has minimal to no downtime, and may include temporary bruising. Results can last anywhere from 6 months to a year.

Fat transfer is a more invasive procedure than dermal fillers, but it can be done in a similar way. The fat is removed from part of your body by mini liposuction under sterile conditions. The fat is then made and cleaned before injecting. The results can be long-lasting.

Photo by Emil Shakov

Wrinkles around the eyes

Periorbital wrinkles can appear after years of eye movement, e.g. B. Squinting and opening and closing the eyes, sun damage to the skin, smoking and aging. The lines can appear on the side usually called "crow's feet" and around the lower eyelid. There are many treatment options.

The most common treatment involves injecting a neurotoxin such as Botox, Jeuveau, or Dysport. It relaxes the muscles that cause the skin to contract for a period of 3 months. The effects can take up to 10 days to be noticed and can be used to treat crow's feet or wrinkles around the bottom lid. Temporary bruising may occur with this treatment.

As with treating hooded skin over the eye, you can also use microneedling with RF to treat this area. The treatment reduces the appearance of wrinkles and lines and has some downtime associated with this procedure such as: B. the skin treatment with a hood.

Photo by Emil Shakov

Herniated fat

Grease can protrude or cause breakage, resulting in bags or garlands with lower lids. This can also be associated with a hollow deformity that creates a line in the tear trough, or extending in an oblique line to the median surface, commonly referred to as the nasojugal groove or nasojugal fold.

Treatment for hernia fat is typically performed surgically, but it can be accomplished by injection. Phosphatidylcholine (PC) is a chemical made from fatty acids, glycerin and phosphorus. It can promote lipolysis and the breakdown of fats when injected directly into fat. This can be used to reduce the amount of fat under the eye over multiple treatments. Treatment results in excessive swelling that can last for up to a week. So prepare to wear big sunglasses!

You could camouflage the lines with dermal fillers. When the filler is performed by a skilled doctor, it will be injected directly into the deformity and can produce immediate results. Overzealous correction can lead to an unsightly side effect called malar edema. This happens when the filler migrates into the superficial layer of the skin, which then leads to puffiness and puffiness. Treatment can be complex, but typically responds with hyaluronidase, an enzyme that dissolves fillers derived from hyaluronic acid.

It is important that only qualified doctors are treated in treating these procedures. Too often, these procedures are performed by unqualified doctors and non-doctors with potentially disastrous results.

Emil Shakov

Emil Shakov, MD, FACS is a registered general surgeon who is the medical director and one of the leading physicians at Youth Fountain ( in Freehold, New Jersey. He has been actively performing medical-aesthetic interventions since 2013. Follow him on Instagram @theyouthfountain.

The article Eyes Are a Window to Your Soul first appeared in Home Business Magazine.


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