All About Eyes

All About Eyes

It is said that the eyes are the window to your soul. I think this is true, but are your eyes also the first place that starts to show signs of aging?

When we meet someone, the first place our focus goes to are usually the eyes. First we notice the color and shape of the eye, and then we notice if the person looks tired, refreshed, happy, sad, young, old, healthy or sick.

The eyes are surrounded by thin, delicate skin, which is why the earliest signs of aging sometimes happen here.

There are a lot of factors that can attribute to aging around the eyes….genetics, anatomy, allergies, smoking, sun exposure, fluid retention, sleep, and general health.

These days there are SO many different crèmes, gels, potions, serums, lasers, skin tighteners, facials, injections, and treatments on the market; it is sometimes hard to choose what will work for your particular eye issue. Sometimes, a little nip/tuck surgical intervention is a possible choice as well.

Here are some of the most common complaints that I hear patients talk about:

1. Upper lids

Heaviness or drooping lids:

This is what you notice when you realize that your eye shadow doesn’t go on as easily as it used to, or your lid drags a little when you put it on. Also, if you can pinch some of the lid and you can see where the skin is pinched after you let go, it is actually excess skin. Many times this is hereditary, and one of your parents might have had the same thing happen to them.

What To Do:

Of course, it is important to always moisturize your skin and keep hydrated (lots of water). Also, do not rub your eyes! This is one of the worst things you can do…it pulls on the very thin skin and will create early wrinkles and crepey skin.

Botox, Dysport, Xeomin:

This will work to help lift the brow and help pull the upper lids up. If this is not enough, the next step from there is an Upper Blepharoplasty, or upper eye lift. This is an easy surgical procedure that can be done either under local anesthesia or under sedation. In this procedure, the area is first marked, and then numbed with a few small injections, and the excess skin is removed. There are some stitches placed that will be removed in a few days afterwards. I have seen Doctors do this one in  office and the patient walked out 2 hours later with her sunglasses on! Some mild bruising and swelling might occur, but cold compresses for the first 2-3 days should do the trick.

Brow Lift (Endoscopic Forehead Lift):

This is the next step if your brow has fallen and Botox and/or and upper lid lift is not enough. This is done under general anesthesia by a qualified surgeon. 4 or 5 very small incisions are made in the hair line, and with a camera attached to a very thin instrument, the surgeon can lift the brow up and then fasten it with tiny attachments. Those attachments are removed about a week later. Sometimes this procedure is done at the same time as an upper lid lift. The recovery time is about 4-5 days, and at most, some people have a headache the day of the procedure.

2. Lower Eyes:

Puffiness or bags:

This can happen from allergies, crying, too much alcohol, and smoking, rubbing the eyes, not enough sleep, too much sleep, age, or genetics. It is really important for you to determine what the cause is first and see if it can be helped by first changing some of your habits. Sometimes just sleeping with your head elevated can reduce the puffiness, or staying away from salty foods in the evening can also help. Sometimes, the bags are actually fat pads that have gathered there. This also can be hereditary. Again, it is really important to keep the skin hydrated and with a good eye crème or serum. Usually it is serums for tightening, crèmes for moisturizing.  If you decide that you want to do a cosmetic procedure, again please make sure that you choose a doctor that has a lot of experience in this area.

What To Do:


Lower blepharoplasty, or lower eye surgery. This is usually done under anesthesia. Your surgeon will make an incision in the lash line that should be invisible, and the fat pads are not removed, but rearranged so that the final result will be a smooth, refreshed look. Years ago, the doctor would remove the fat pads all together, but they found out that the patient had an indentation, or trough that looked hollow from removing the fat. Now, it has been perfected, and the surgeon actually rearranges the fat so that it is smooth under the eyes. It is an easy procedure, and some bruising and swelling may occur for a few days.


Fraxel: This laser can be used all over the face, but done under the eyes it stimulates collagen production tightens the skin, and helps shrink pore size. This can be done with just numbing crème applied an hour before. There is some redness and swelling after for a few days, but the results are great! I am a big Fraxel fan!

Encore Laser: Active FX and Deep FX:

This is a deeper laser that is done under anesthesia. It is a C02 fractionated laser that goes deeper into the skin than Fraxel. It can also be used on the entire face. It also tightens skin and really works for the crepey thin skin under the eye. It helps stimulate collagen production, and usually only one treatment is needed. The down time is a little longer, about 5-7 days of redness, but the results are awesome!


Anytime you have anything done on or around the eye area, it is important to sleep elevated for the first week and use cold compresses as much as possible. Also, do not take any blood thinning products for 2 weeks before having a procedure done as it can cause bleeding and bruising, leading to complications.

Dark Circles:

Many of us have those lovely dark shadows circles under or eyes that can look progressively worse if we are tired. Again, genetics plays a part in this one too.

The dark circles are actually a break down of blood vessels that show through the skin under the eye. Some people have thinner, more translucent skin and the color will look darker and deeper. Others will notice them more when they are tired.

What to do:

There are some laser treatments that claim help with dark circles, such as the YAG or Erbium lasers. They help to tighten the skin as well as decrease the purple color of the vessels.

Get as much rest as possible and also use a crème or eye gel that contains Vitamin K. This vitamin helps to combat further break down of the very small vessels.

Buy a great concealer! This is a key product that every woman must have…I have tried many of them and have finally settled 2…Time Balm by the Balm sold at Sephora, and Touche Eclat by YSL for highlighting.

Hollowness under the eyes:

This is also called a tear trough, and becomes more noticeable as we age. It is a hollowing under the eyes where either the fat has gone away or migrated.

What to do:

Filler such as Restylane or Juvederm

Your doctor can do this in the office in 30 minutes. Basically he or she injects the product with a small needle into the hollow area and fills it back up. No anesthesia is needed and you can go back to work the same day. Mild bruising may occur that can be covered by concealer (see above). It lasts approximately 6 months depending on the patient.

Fat transfer (Fat grafting)

This is done under anesthesia by your doctor. Fat is taken from another portion of your body (usually the abdomen) and transferred into the under eye. (It can be placed anywhere in your face to add fullness, but we are focusing on the eyes right now). It lasts anywhere from 1-3 years and the result is a natural, rejuvenated look. There is mild bruising and swelling as well, but usually taking a weekend off is enough time to heal.

Crows Feet:

We ALL know what these are!  As we age, the muscles around the eye get weaker from smiling, squinting, grimacing, and general movement. Also, sun damage and not wearing eye protection can cause these lines to get deeper.

What to do:

Again, a good eye crème is a must, preferably one containing Hyaluronic Acid, which helps plump up the skin. It is the same thing that Restylane and Juvederm are made of, but the crèmes are topical. Hyaluronic acid is a sugar based molecule that binds to water, which causes plumping and volume. Vitamin C and a Retinol product in the eye crème is also a great option because it speeds up cell turnover.

Botox, Dysport, Xeomin:

Of course we all have heard of Botox! Dysport and Xeomin are the other 2 injectable toxins that freeze the muscle and can literally erase crow’s feet from the face if started early enough and maintained. It usually involves about 3 or 4 shots with a small needle around the eye area and starts to work in 1 to 7 days. The results can last from 3 to 6 months and mild bruising may occur, but you can go to work the same day. Learn more about our Botox training in Nashville.

Eyelash options:

Thin lashes: As we age, the eyelashes that were once thick and full become thinner and sparse. Fortunately, there are some fun new products and services you can try to help your lashes look fuller and longer.


This started as a glaucoma medicine for patients with Glaucoma. Patients using the eyedrop’s began to notice that their lashes were growing in fuller, thicker, and longer! The company Allergan then released it for cosmetic use, and thousands of women (and men) are using it every day. It is sold at your doctor’s office, and is applied every day on the lash line of the upper lid. It takes about 6 weeks to see results, so be patient!

Lash Extensions:

These are individual lashes that are glued to your lash line by someone trained to do this procedure, usually an aesthetician.  You can do just the outer corner of your eye, or you can choose to the entire upper lid. They are really fun, and if done correctly, can last for 2-4 weeks.

To summarize, there are many different options you can do to keep your eyes looking youthful and fresh! From crèmes, to surgical procedures, non-invasive to more invasive, you can choose what your needs are and go from there. Sometimes, all you need is a great eye crème and maybe later down the road you will want to progress to something more…it’s up to you! As always, make sure that any treatment advice you seek comes from a professional that has been properly trained in the area you are interested in!

Sylvia Silvestri, RN