The skin around the eye is one of the most delicate areas of the entire body. Over time, gravity, stress and years of rubbing to remove mascara can take their toll. As a result, the upper lids start to droop and the lower lids darken and swell. DR SYLVIA RAMIREZ of Cutis Medical Laser Clinics tells us why this happens and what can be done to stop the sag.
What are the most common complaints that people have about their eyes?
Most people that I see are unhappy about under eye bags, discoloration and droopy upper lids.
Let’s tackle these one at a time. The droopy lid – what causes this?
As we age, the skin around the eyelids becomes thinner. Three different layers of skin are affected – the epidermis or top layer, the dermis or middle layer, and the subcutaneous fat layer underneath. The dermis is where we store collagen and elastin. Collagen is responsible for skin firmness, and elastin for elasticity. As we age, both start to decrease, causing the skin to become lax. In addition, the subcutaneous layer starts to lose volume, which causes the skin to sag further.
What exactly is sagging – the forehead, the eyebrows or the eyelids?
It’s a combination of all three. Everything begins to slowly move downward as collagen, elastin and volume decrease.
Does this happen to the lower lids too?
Yes. The skin around the eye is already thinner than the rest of the face. When collagen, elastin and subcutaneous tissue are lost underneath the eye, so-called tear troughs are created. This is evident when a ledge forms between the eye and the cheek.
You mentioned three layers of skin; how does ageing affect the top layer?
Ageing is associated with thinning of the epidermis and reduced epidermal turnover. Pigmentation is more evident because of accumulated sun damage, hormonal changes and leakage from fine blood vessels. Discoloration due to melanin and haemosiderin deposits, combined with volume loss, result in under-eye circles becoming more prominent.
Do these problems generally happen to both lids at the same time?
Changes tend to occur to both eyes at the same rate, generally when people are in their 20s and 30s. But it really depends on the person. Heredity plays a big role. For example, someone with deep-set eyes will notice hooding – this is when the upper lid hangs over the crease – much later in life, whereas people with so-called Asian or single eyelids usually notice drooping or hooding at a younger age.
How can we combat these problems?
First, get the proper amount of sleep. Lack of sleep causes blood vessels to show more and emphasises hollowness. Also, avoid eating salt late in the day, as this causes eyes to swell in the morning. If this doesn’t sufficiently correct the problem, then Botox, fillers and laser treatments can be considered.
How does Botox lift a droopy eye? Given that it relaxes the muscle, this sounds counter-intuitive.
There are muscles in the eyes, mainly on the outside and between the brows, which cause the eyelids to appear heavy. These muscles pull the eyelids closed, and over time they cause the eyelid skin to droop. When Botox is injected into these muscles, they relax, and their ability to depress the eye is reduced. This gives a lift of one to two millimetres, which may not be enough for some people. Another option is injecting fillers, such as Restylane or Juvéderm, directly under the brow. This lifts the eyelid by creating a broader ledge for the upper lid to hang from. Think of it like hanging a dress on a wide hanger rather than a wire one. Also, lasers build collagen and elastin while tightening the skin, which can create a very subtle lift.
Apart from getting enough sleep and avoiding excessive salt intake, what can be done for under-eye bags and circles ?
Fillers are a great way to combat hollowness and loss of fat under the eyes. Depending on the eye structure, fillers can almost instantly reduce the appearance of under-eye bags. Haemosiderin staining is caused by iron pigment that leaks from very fragile veins around the eyes and is very difficult to treat – it’s almost like a tattoo. Lasers are able to dissolve this staining and tighten the skin around the eyes.
There are so many options. How does a person choose the best one?
It’s important to analyse the factors that are causing the problems. Is it laxity? If so, lasers are great to improve skin quality. If someone needs a quick fix with no downtime, Botox or fillers may be best. Lasers and tightening treatments build collagen, but these take some time. I am a total believer in combining treatments, because most people have problems in more than one layer of the skin.
For more information, call 6801 4000 or visit cutislaserclinics.com.