The thinnest skin in our body is our eyelids, and they are very susceptible to sun damage and other issues that cause them to age. Reducing the appearance of eye aging can be difficult and may require multiple modalities but fantastic results can be achieved. Dr. John Burroughs, oculofacial plastic surgeon, discusses his top tips and procedures for treating and keeping the eyes looking beautiful. The eyes are the windows to the soul and helping them look their best helps you look your best.
Non-Surgical & Minimally Invasive Treatments
- Prevention
A great way to delay crow’s feet from forming is to protect the eyes from UV exposure. Wearing a high-quality pair of sunglasses with an oversized or wrap-around frame with at least 98% UV protection protects the skin and lessens the squinting-caused wrinkles.
Also, important to prevent and treat eyelid wrinkles is to use a high quality physical sunblock such as those offered by Elta MD and SkinCeuticals that are formulated to both protect and be well tolerated by the sensitive skin around the eyes. SkinCeuticals also has helpful antioxidant serums (e.g., CE Ferulic containing Vitamins C, E, and Ferulic Acid; Phloretin CF with Vitamin C, Phloretin, and Ferulic Acid) that work synergistically together offering protection and healing from the free radicals created by UV exposure and help preserve healthy collagen. Living in Colorado it’s important to remember that our atmosphere is thinner allowing a very high amount of harmful bombarding UV rays that are even present on cold, cloudy, and rainy days. Daily sunblock application, on exposed skin and around the eyes, is the best defense against damaging UV radiation.
- Cosmeceuticals
Topical cosmeceutical products are important when trying to prevent or treat wrinkles around the eyes. Dr. Burroughs recommends SkinCeuticals, founded by a dermatologist, exclusively as they do rigorous scientific research to ensure their products penetrate into the skin and provide scientifically measurable results. Using a good moisturizer around the eyes can not only immediately plump those fine lines around the eyes but helps prevent deeper lines and wrinkles exacerbated by dryness, which most of our patients and clients suffer from living at our high altitude, dry climate. Eye creams, such as SkinCeuticals A.G.E. Eye Complex are typically heavier than moisturizers used on the rest of the face, since the skin around the eyes have very little sebaceous glands. The A.G.E. Eye Complex has synergistic peptides that help with collagen and elastin breakdown by helping the glycation in the skin thereby helping the skin thicken and reducing wrinkles. Additionally, SkinCeuticals has “HA Intensifier,” which helps improve the hyaluronic acid levels in the skin causing plumping and improvement of the fine lines. Vitamin A in low-doses can also help eliminate the appearance of fine lines and wrinkles since it speeds up cell turnover and boosts collagen production, as well as evening out skin tone and texture. SkinCeuticals also has “AOX Eye Gel,” which helps with puffiness and damage from oxidative stress. Retinol is another important skin care regimen that helps promote superficial epidermis turnover allowing your skin to look and feels its freshest.
SilkPeel DermalInfusion is a great procedure, combining comfortable microdermabrasion with dermal infusion of serums to help rehydrate the eyelid and facial tissues. This skin hydration feels good, and leaves the skin looking more radiant and fuller for several days without any downtime. Hydration of the eyelid tissues reduces the appearance of fine lines providing a more relaxed youthful appearance.
- Skin Tightening
There are several skin tightening treatments available that work in varying ways to reduce the appearance of wrinkles. Forma is a radiofrequency treatment that applies gentle heat to help tighten the skin and promote collagen formation. It is quite comfortable to have performed and requires no anesthetic injections or numbing and has no downtime.
There are other radio frequency devices that emit high-power energy in the form of electromagnetic waves that create heat in the deeper layers of skin to contract tissues and trigger a wound-healing response. Fractora provides non-ablative skin tightening that may be used on all skin types by creating micro-cores of damage below the skin that stimulate collagen production. These waves heat up the dermis, stimulating collagen and ultimately result in skin tightening. When there is lifting and collagen production, the appearance of fine lines and wrinkles will also be reduced. Shown is an illustration showing how the Fractora delivers radiofrequency heat to deeper tissues to promote collagen growth.
Inmode’s Facetite uses a wand that goes below the skin surface to also promote collagen production and skin tightening. It may be used in the cheek areas around the eyes to further tighten the skin and reduce areas of tissue swelling. Another modality used for a long time with great results are chemical peels. These can reach superficial depths (e.g., salicylic, lactic acid, Jessner’s) to more medium depth such as TCA (trichloroacetic acid). These peels can correct pigmentary changes as well as tighten and smooth the skin.
- Botulinum Neuromodulators
Neuromodulators have been used for over 20 years to reduce the appearance of wrinkles around the eyes. They are injected into the muscles that cause the expression lines. Muscle contractions are improved for about 3-4 months. Botulinum toxin was originally used to treat the glabella region, which can develop deep folds (“the 11’s”) from frowning. Its cosmetic applications have since expanded to the crow’s feet, forehead lines, and other areas. Wrinkle blocker injections can also be used to widen the opening of the eyes, gently lift the brows, and to even help you feel better and less depressed because of how the face sensation feeds back to our emotion centers in the brain. The great thing about neuromodulator wrinkle blocker injections as they can be done quickly and have no downtime.
- Dermal Fillers
Dermal fillers can, in the hands of experienced injectors, be used to fill in the hollows under the eyes, and sometimes also help the crow’s feet in certain circumstances. Fillers are fantastic as they don’t carry the same risk or downtime as surgery. Dr. Burroughs has taught his techniques to others, and become well known for his “filler blepharoplasties.” Dermal fillers and neuromodulators work well in conjunction with one another to produce long-lasting synergistic results. See a lower eyelid “filler blepharoplasty” result below.
- Intense Pulsed Light (IPL)
IPL uses a very intense light that is delivered in quick short pulses that helps with pigmentary unevenness and fine superficial vessels. Dr. Burroughs and Springs Aesthetics use a very powerful unit by Inmode (Lumecca) that can deliver the results in 3-4 sessions while others take 5-6. Lumecca also uses a cooling head to make the treatments quite comfortable despite the higher power. Interestingly, Dr. Burroughs has found dry eye patients can achieve improvement of their dry eyes as the IPL helps loosen the thickened oils in the eyelid glands to be able to express better thereby helping provide a healthier and better feeling tear film.
- Microneedling & PRP
Microneedling creates micro-channels (tiny holes) in the skin, and is performed under the direction of a physician 3-4 weeks apart. Needling in general stimulates the skin’s natural ability to heal itself. Cosmetic needling uses very fine needles with a depth of 0.1- 0.4 mm or more to allow products to penetrate more effectively. These micro-pores allow pathways for topical products to enter the skin better and stimulating cellular turnover reducing the appearance of fine lines and wrinkles. Needling can help with the crow’s feet and other fine eyelid wrinkles. An additional adjunct is the use of PRP (platelet rich plasma) that delivers helpful factors to the tissues. These are obtained from your own blood, so they are very safe and help the tissues rejuvenate by bringing concentrated blood factors to your aging tissues to help restore them. PRP may also be given in conjunction with dermal fillers to work synergistically and better together.
- Fat Grafting
Fat grafting uses your own fat taken from unwanted locations to areas where it may be helpful, such as areas of deflation around the eyes and face. The eyes tend to deflate in the brow and under eye areas. Another great location to add supplemental fat is over the cheek bones to restore the “Ogee” curve of youth and to the temple areas if they have become hollowed out.
- Medical Grade Eyelid Hygiene & Scrubs
Our eyelids can become damaged along the margins from a build-up of dead cells, bacteria that form what is called a biofilm. This can plug the oil gland openings that provide essential oils to the tear film of our eyes. This can lead to red, dry, unsightly, and uncomfortable appearing eyes. Because Dr. Burroughs trained as an ophthalmologist prior to his plastic surgeon training, he is uniquely qualified in the aesthetics field to ascertain why your eyes (ocular surfaces) aren’t looking their best and offer treatment solutions and future preventative strategies against harmful eyelid conditions. Springs Aesthetics offers prescription strength eyelid hygiene products such as Avenova that will treat the harmful bacteria and even mites that can grow on the eyelids and eyelashes. For the most severe cases, he can treat the eyelid margin with BlephEx—a medical device that mechanically, thoroughly, and comfortably treats and cleans the lid margins. This helps re-open the oil gland ducts and provides the cleanest possible eyelid margin ridding the margin and lashes of unwanted bacterial biofilm residue and Demodex mite infestations. The healthier the eyelids the healthier the eyes will be and look their very best.
Surgical
The eyelid skin as it ages suffers UV damage and gets stretched from gravitational effects. These concerns can be improved by removing excess skin to restore the upper eyelid platform and/or to smooth the lower eyelid wrinkles. Prolapsing fat may be sculpted and repositioned to improve the appearance of bags. These surgeries are called blepharoplasty. Sometimes one or both eyelids can become droopy and less open because of the eyelid margin sagging. This is called ptosis, and oftentimes can be fixed surgically on the inside of the eyelid without an external scar. The eyelid shape can also be improved to a more “almond shape” or to improve lower eyelid sagging by lateral eyelid procedures and midface lifting. Dr. Burroughs has performed around 20,000 procedures and surgeries around the eyes, and even teaches at cosmetic surgery meetings sharing his techniques with other surgeons and cosmetic dermatologists. Dr. Burroughs has also published many of his techniques in peer-reviewed medical journals and surgical textbook chapters.
Because there are so many options, Dr. Burroughs and his staff team can provide a consultation to discuss your specific needs and optimized treatment plan. Many don’t have the time for healing from surgery, which is why Dr. Burroughs has researched the best non-surgical modalities to help patients either through non-invasive or minimally invasive treatments to look and feel their best. Your eyes are precious jewels and worth taking care of, so trust your eyes to an eye expert.
Call for a consultation (719-473-8801) with Dr. John Burroughs or his aesthetic team at Springs Aesthetics.