What Can I Do About My Tired Looking Eyes?
When I look in the mirror, the eyes looking back at me look tired even after a good night’s sleep. Lately even my co-workers have asked if I’m tired, even when I’m not. What can I do?
Tired-looking eyes are almost always because of bags around the lower eyelids. These bags sometimes show up as early as the mid-20’s, but much more frequently become a problem after the late 30’s. The cause is a combination of bone structure, loss of skin and soft tissue strength and elasticity, and descent of fat around the eyes. Treatment varies with the cause of the lower eyelid bags, and can range from treatments of the skin [creams, botulinum toxins (Botox, Dysport), peels and lasers], treatment of the hollows left behind by fat loss or descent (fillers like Restylane), and treatment of the bags and skin laxity (lower eyelid lifts, or blepharoplasty).
Topical treatments only affect the texture and color of the skin, but can be helpful in early aging and to complement more intensive treatments. Retinoids, Vitamin C creams and newer, sophisticated topical treatments containing growth factors can strengthen the skin and reduce fine lines by increasing the density of collagen and elastin in the skin. Many of these products are available over the counter, but I prefer the more intensive products available in physicians’ offices. At Westlake Dermatology and Cosmetic Surgery, we screen products we offer for efficacy and outcome. At the end of the day, you can spend a little less for over the counter products with variable efficacy, or a bit more for a product known for its quality at a professional office like mine. Here are some of my favorite eye products:
- Retinol (Vitamin A) Products:
- Vitamin C Products: SkinCeuticals AOX+
- Growth Factor Products: NeoCutis Lumiere Riche Bio-Restorative Eye Cream and SkinMedica TNS Eye Repair
Neurotoxins (Botox, Dysport) can reduce crow’s feet and fine lines around the eyes by reducing the pull of the muscle (Orbicularis oculi) on the skin. The skin is very thin around the eye, so by reducing the pull a little the lines improve significantly. What’s more, if the pull is reduced over time, say one year, then the deeper lines will actually release. This is the best preventative treatment to insure a smoother complexion with age. The effect of botulinum toxin is limited to 3 months, when the muscle strength will return to its pre-treatment state.
Peels work by removing a portion of the outer layer of skin. Superficial peels are effective in smoothing the texture of the skin but do little to the underlying structure of the skin. However, this no-down-time peel can allow for products (see above) to penetrate more effectively, shortening the time it takes them to affect the underlying structure.
Medium peels (Jessner’s-TCA 30%) penetrate through the basal lamella of the skin, allowing structural improvements to the skin with healing. The densities of collagen and elastin actually increase in the dermis, creating physically smoother, tighter skin. These peels also effectively diminish skin discoloration caused by sun damage. However, because these peels actually cause a lot of crusting and peeling, the down time is significant. Up to 2 weeks are required to recover, and up to 2 months for all redness to dissipate.
Deep peels (Hetter peel) penetrate more deeply through the dermis. They are reserved for the most severely wrinkled, sun damaged skin.
Cosmetic lasers have come a long way in improving skin quality with less down time. A full discussion of lasers is beyond the scope of this blog, but can be found on our website at https://www.westlakedermatology.com/cosmetic-procedures/laser/.
Dermal fillers are used to camouflage lower eyelid bags. My preferred filler for the eyes is Restylane. It lasts about one year around the eyes and can be dissolved if there is any lumpiness or irregularity. With any filler, the experience of the injector is critical to achieving the best, natural-looking result. Restylane is placed in the hollows between the eyelid bags and cheek, effectively camouflaging the bags. For examples of my patients having had Restylane for their eyes, please see https://www.westlakedermatology.com/cosmetic-procedures/injectables/restylane/before-and-after-photos.
Blepharoplasty (lower eyelid lift)
Eyelid surgery does little for the fine lines of the skin. However, it improves the lower eyelid by tightening the skin, removing excess eyelid fat (bags), and filling hollow areas by moving eyelid and cheek fat into those areas. If skin tightening is not required, the procedure can be done with no external incision (the incision is inside the eyelid instead of outside). In this case the skin can be simultaneously smoothed with a light or medium peel. If eyelid bags appear at a younger age, it is best to perform blepharoplasty surgery at a younger age and not to wait until things get worse. In that way, less surgery need be done and the results allow for the eyes to look better for longer in life. It is rare to require a second blepharoplasty when the first was performed skillfully at a younger age.
For more information about eyelid surgery, see our website at https://www.westlakedermatology.com/cosmetic-procedures/plastic-surgery/eyelid-surgery/ and https://www.westlakedermatology.com/cosmetic-procedures/plastic-surgery/eyelid-surgery/before-and-after-photos/