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How to rejuvenate tired eyes without surgery

Before and after photos of the under-eye hollow treated with hyaluronic acid filler

The tired look can come from fine lines around the eyes, hollowing and darkening under the eyes, excess skin of the upper and lower eyelids, or lowering of the eyebrows. Dr. Prasanthi Kandula likes to approach a cosmetic consultation about eye rejuvenation by thinking about the five R’s – Relax, Refill, Restore, Refine, Realistic. The first four R’s address the possible causes of a tired look, while the last one deals with patient expectations.

RELAX

We can treat the dynamic wrinkles (those from muscle motion) with neuromodulators such as Botox, Dysport, Xeomin, and Jeuveau. Neuromodulators can help soften the crow’s feet and the lines between the eyebrows and give the eyebrows a lift when injected into select areas. Treatments are preformed typically every 3-4 months.

REFILL

As we age, we lose volume under our eyes (the tear trough) and the fat pads become more noticeable. We can camouflage the fat pad and fill the hollowing with hyaluronic acid fillers such as Juvederm and Restylane. The use of these products in the under-eye area is off label, but expert injectors have been employing them safely for years. Risks include bruising and swelling, with other side effects being exceedingly rare. We do recommend that this procedure only be performed by experienced board-certified physicians. The results typically last a year or more.

RESTORE

The eyelid skin is thin and delicate and prone to aging before other areas of the face. We have many devices and tools that can help rebuild collagen and firm the skin.

• Thermage and Pellevé are both radiofrequency treatments that help tighten the eyelid skin with a series of treatments. There is minimal downtime and the procedures are very well tolerated.
• Microneedling and microneedling with radiofrequency have become popular over the last several years. After numbing cream is applied, a pen with multiple thin needles penetrates the skin. The downtime includes swelling and bruising for up to a week. A series of monthly treatments is recommended as well.
• The fractional ablative carbon dioxide laser is more aggressive than the above treatments, but it also gives more dramatic results. It provides maximal tightening by creating thousands of tiny treatment zones that stimulate the skin to produce new collagen and repair itself. This procedure is termed the “Madonna lift”. Swelling and redness are expected after the procedure, but typically resolves within 5-7 days. A series of treatments, spaced several weeks apart, may be required.

REFINE

Sometimes there are prominent veins or true pigmentation under the eyes. To help reduce their appearance, we turn to lasers including pulsed dye laser, Nd:YAG, or picosecond lasers. These lasers are almost always used in combination with the treatments above. Additionally, patients commonly request an eye cream to add to their skincare regimen. Daily use of eye creams with active ingredients such as vitamin C, hyaluronic acid, and retinol may complement the above treatments, but are inefficient at producing noticeable results alone.

REALISTIC

As physicians, it’s important that we set realistic expectations for our patients. While neuromodulators and fillers produce noticeable improvements within a few weeks, the radiofrequency, microneedling, and carbon dioxide laser take 3-6 months to see full results. A combination of the above treatments may help refresh the eye area in the right candidate. There are however limitations to these cosmetic procedures which may not be a complete substitute to surgical intervention.

If you feel that your eyes look tired, we recommend a consultation with your cosmetic dermatologist who can review nonsurgical eye rejuvenation options and determine if they might be a right fit for you!

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