2 Plastic Surgeons on Crow’s-Feet, Dark Circles, and Everything about Eyes
We like to wake up bright, smooth, and wide-awake around the eyes. But late nights, allergies, genetics, sun exposure, and the sands of time have some less than desirable ways of making their presence known. Two top plastic surgeons take us through what’s possible in the eye-refreshment department, from eye creams and sleeping-position strategies to lasers, ultrasound, injections, and even surgeries.
“There are many approaches, and they work to differing degrees for different people,” says Dr. Julius Few, a plastic surgeon and the founder of the Few Institute for Aesthetic Plastic Surgery in Chicago. Because the skin around your eyes is 40 percent thinner than the skin on the rest of your face, it’s more susceptible to environmental damage and more prone to showing signs of aging, says Dr. Chaneve Jeanniton, a New York oculofacial plastic surgeon and the founder of Epi.logic skin care.
In-office procedures can be more powerful and more permanent, but at-home treatments can really help, both agree. Either way, that part of the face always needs to be approached very gently: “The eye area is delicate, in both structure and function, because the eyelids’ micromovements are integral to protecting the eyes,” says Jeanniton. “Treatments need to avoid irritation of the skin or eyes, and they cannot compromise the blink mechanism that maintains eye health.”
Sun protection is hands down the best way to prevent the fine lines and wrinkles we get around our eyes. “Regardless of whether it’s sunny outside or not, wear sunblock,” says Few. “The sun is the root cause of wrinkling, and when skin is protected, the area responds better to hydration.” Jeanniton adds that sunglasses and hats are always a good idea.
Both Few and Jeanniton also recommend daily vitamin C to help skin minimize free radicals and free radical damage, and constant hydration with ingredients like hyaluronic acid. You can find both ingredients in goop’s vitamin C serum (which is for all over the face and shouldn’t be used too close to the eyes or it could cause stinging) and in H. Hazel’s eye gels.
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Both surgeons suggest using retinoids or retinol at night. “Vitamin A derivatives have been shown to stimulate collagen production,” says Jeanniton. “Used regularly, they can firm and smooth the skin under and around your eyes. However, because eyelid skin is so thin, make sure it’s a gentle formula.”
“Ultimately, I look for the bigger issue that’s creating the crow’s-feet,” says Few. “Is it skin, muscle activity, or volume loss? Then I prescribe and apply the best options.”
Both Jeanniton and Few say the best treatments for crow’s-feet are often neurotoxins. “They work by softening the muscle contractions that cause furrows around the eyes, and the natural-looking results last for three to four months,” says Jeanniton. “Because crow’s-feet are also due to a loss of collagen and elastin, I inject small amounts of hyaluronic acid filler into the dermis of the skin—this diminishes deep, pronounced lines for nine to twelve months.”
Few also likes to use ultrasound, radiofrequency, and fractional lasers for crow’s-feet. “Ulthera, an ultrasound-based collagen-building therapy, can also be very effective for wrinkling around the eyes,” says Few. “With a single treatment of the monopolar radiofrequency treatment Pelleve, the skin appears immediately smoother—it’s like taking a hot iron to a wrinkled blouse but without any pain. And the Halo fractional dual-mode laser is great for wrinkled skin, without the traditional discomfort, hassle, or pain.
There are many variables at play in terms of what causes puffy eyes: fluid retention from late nights, too much drinking or salty food, and irritation from seasonal allergies. “And as we get older, muscles and other supportive tissues around the eye relax,” says Jeanniton. “That, paired with waning elasticity in the skin, can cause fat that was once at deeper levels to migrate closer to the surface, causing eyelid bags. Because these bags are caused by changes in the underlying structures of the face, topical products and treatments can’t completely correct them.”
Massage, Jeanniton says, can help mild fluid retention: “A gentle gua sha or facial roller massage can decongest puffy eyes temporarily. Take note though: The fluid will re-collect if the underlying cause isn’t addressed.”
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Eye treatments made with caffeine, like the ones from KORA Organics and Alpyn Beauty, can also help. “Caffeine is a vasoconstrictor, which means it shrinks the blood vessels under the skin and temporarily reduces puffiness around the eyes,” says Jeanniton. Cooling works, too: Elderflower in Tammy Fender’s eye gel has this effect. There are also DIY options. “One of our international patients was traveling to Russia for work and forgot to bring her products from our medical-grade skin-care line,” says Few. “We had her use cool-water-soaked green tea bags, alternating with cucumbers and a light skin moisturizer with sunscreen—she loved the short-term benefits.”
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“As we get older, muscles and other supportive tissues around the eye relax,” says Jeanniton. “That, paired with waning elasticity in the skin, can cause fat that was once at deeper levels to migrate closer to the surface, causing eyelid bags. Because these bags are caused by changes in the underlying structures of the face, topical products and treatments can’t completely correct them.”
The obvious approach to puffiness—to get more sleep—is still one of the most effective. “Especially with the increased use of FaceTime and Zoom, bags can look worse than ever,” concedes Few. “Eight hours per night is helpful. When we’re asleep, we subconsciously microblink our closed eyes. This helps return the retained fluid that can accumulate during a given day back into the body, making the eye area look and feel less tired and smoother.”
Sleep on your back if you can. “Cosmetically, it’s the best position for the eye and facial areas, according to several studies,” says Few. “If sleeping on the back is an issue, try a medical-grade pressure-release pillow, like the one by enVy.” And for allergies, Jeanniton suggests something as simple as taking an antihistamine to ease some puffiness. Homeopathic formulas like Genexa’s Allergy-D can also calm eye irritation.
For mild undereye bags, Few and Jeanniton inject hyaluronic acid filler to camouflage the convexities. “When undereye bags are more pronounced, I perform a surgery called blepharoplasty, with hidden incisions to restore a smooth contour and remove the bags,” says Jeanniton. Few is also fond of less-invasive treatments for unwanted fat bags. “If a patient wants to avoid surgery and they have mild to moderate puffiness of the lower eyelids, superheating the tissue with either focused ultrasound—Ulthera—or radiofrequency can be very effective,” he says.
The shadowy dullness we get beneath our eyes happens for a number of reasons: Chronic rubbing, prominent blood vessels visible underneath the skin, a genetic predisposition, hormone-induced darkening, or pigment (melanin) buildup in the skin can all play a part. “Dark circles are also typically the result of volume loss between the lower eyelid and the cheek,” says Few.
“Look for skin-brightening ingredients, like retinol, vitamin C, kojic acid, licorice extract, or niacinamide, which can all be helpful for skin discoloration, says Jeanniton.
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Done right, cream-based foundation and concealer make a real difference. “I always mention it to my clients,” says Few. “A shade two or three tones lighter than the surrounding skin can work very natural-looking magic.” (We also love makeup artist Bobbi Brown’s embrace-your circles approach.)
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To address concavity underneath the eyes, both Jeanniton and Few inject hyaluronic acid filler. “This is the most requested treatment in my practice,” says Jeanniton. “It brightens the area by adding volume and reducing the shadowing effect. There’s relatively little downtime, and results typically last one to two years.”
Few uses a red intense pulsed light laser—traditionally used for laser hair removal in skin of color—for treating hyperpigmentation in the darkest skin groups. For blood vessels, Few prefers a laser called BBL (BroadBand Light): “It’s our tool of choice and works really well for that issue.”
To fade excess pigment, Jeanniton uses in-office chemical peels specially formulated for delicate eyelid skin. “Retinoic acid, kojic acid, and vitamin C all lift discoloration and can be titrated for safety around the eyes,” she says.
Droopy Eyebrows and Eyelids
Extra fat hanging down around the brow happens when a brow fat pad has slipped out of position. “Microcurrent can produce nice lifting results around the eyes and brows,” says Jeanniton. “There are easy-to-use home devices available.”
Few loves to use Ulthera for this issue. “The microfocused ultrasound treatment lifts the brow, making the eyelid appear less droopy, especially when combined with neurotoxins,” he says. Jeanniton also injects neurotoxins and hyaluronic fillers to create a brow lift of sorts. “This works by allowing the brow depressor muscles to relax, giving an advantage to the brow elevator muscles, and the filler reinflates and supports the sagging brow,” she says. “Although I love this procedure, I always advise my patients not to expect results comparable to a surgical brow lift.”
In older patients (those over fifty or so), however, neurotoxins above the brow can create an unnatural look, points out Few. In addition, improperly placed forehead injections can actually cause a droopy brow, Jeanniton points out. Both surgeons prefer surgery for this area above all. “Blepharoplasty with ptosis repair,” says Few. “The surgery involves removing excessive skin from the upper eyelid, then using stitches to repair the torn ligaments inside, which are responsible for opening the eyes.” Jeanniton also relies on ptosis repair. “Sutures are strategically placed to amplify the elevating power of eyelid muscles, restoring the lid back to its proper position,” she says. “I commonly perform this in my office. The surgery takes about thirty minutes, and I advise my patients to take a week off from their usual routines to allow for healing. Getting to see the boost in confidence you can give someone by restoring symmetry to their eyes is easily one of the most satisfying aspects of my job.”
This can sometimes be a manifestation of an underlying illness, like sinus disease, says Jeanniton. “For those noticing significant asymmetry between the two sides or progressive changes, I’d check in with an oculofacial plastic surgeon for an evaluation,” she says. “Deep-set eyes can also sometimes manifest with a hollow in the space below the upper orbital bone, between the eyelid and the brow. A hollow in this area can cause someone to look older than their age or frail. Very cautious filling with small amounts of hyaluronic acid filler can help diminish the hollowing effect and significantly rejuvenate the appearance. This is one of the most expert-level filler procedures, requiring a great degree of nuance to avoid complications, so I’d recommend consulting with only an oculofacial plastic surgeon for this concern.”