Windows to the soul? Come. On. In truth, once we hit a certain age, our eyes reveal things far less existential, like our precise level of exhaustion, our sun protection shortcomings, even the misguided vanity of our despectacled youth (the resultant crow’s feet, now perfectly evident without squinting, irony of ironies).
Happily, a trip to the dermatologist can be equally revelatory, illuminating an expansive landscape of treatments designed to rejuvenate the eye area by smoothing under-eye hollows and bags, hoisting collapsed brows, and ironing out those corner crinkles that accompany our widest smiles. Here, Brian Biesman, MD, a clinical assistant professor of dermatology and ophthalmology at Vanderbilt University Medical Center in Nashville, TN, shares the latest ways to keep our eyes from betraying our age.
A JUST-RIGHT REMEDY FOR SHADOWY HOLLOWS
“A day doesn’t go by that I don’t do multiple tear-trough injections,” says Biesman. That’s derm-speak for injecting under-eye hollows with filler to smooth the transition from the lower lids to the cheeks, for a bright, rested, utterly zen appearance. Thing is, “adding volume here is tricky, as the filler and its placement have to be optimal to avoid puffiness and unnatural contours.”
The ideal filler has to be stiff enough to give some body, but soft enough to flow nicely, and not leave lumps or bumps, or attract unwanted water. (Quick side note: The most popular fillers are those made with hyaluronic acid (HA), a safe sugar molecule naturally found in the body, which also happens to be a water-binding humectant. HA’s moisture-magnet quality can sometimes be a help—like when restoring lost fullness to the cheeks—but is often a hindrance, making it difficult for doctor’s to gauge an adequate fill since they have to account for potential post-shot inflation.)
Restylane Refyne, a non-swelling newcomer to the injector’s armamentarium, is essentially Goldilocks-approved: “Not too soft, not too firm, it sits right in the middle, and it’s remarkable how even a modest amount makes a significant improvement,” says Biesman—a definite plus when you’re paying by the vial. Refyne’s unique consistency also allows doctors to address the outer under-eye area, bordering the temples. “For a long time, we focused only on the dark inner corners,” he explains, “but now we have a product that allows us to very subtly correct age-related changes to the lateral area for a much more youthful result.”
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A LID LIFT, SANS SCALPEL
It used to be, when one’s eyelids began to droop and fold Shar-Pei style, rendering her favorite eye shadows useless, removing the lax skin via surgery was the only recourse. But today’s inventive derms and surgeons can now pick up the slack with fillers and neuromodulators (like Botox, Dysport, and Xeomin) instead of scalpels. As Biesman explains, “Part of what makes the eye look youthful is having that generous space on the top lid for makeup, and also having a nice 3-D projection to the area between the eyebrow and the upper lid.”
Over time, the fat pad responsible for that roundness deflates and descends, dragging skin down with it. Surgically resuspending the fat pad can help lift the skin and restore that contour.
But for some—generally those under 50—“we can achieve an impressive lift with injectables alone,” Biesman says. “While you don’t hear much about it, filling the space between the eyebrow—just below the hairs—and the top lid can boost a fallen, or genetically heavy, brow for about one year.”
The result is even more dramatic when he combines fillers with toxins, which can be strategically injected to relax the muscles that pull down the eyebrows. As a bonus, he adds, “we can precisely contour a patient’s brows while we’re at it—emphasizing an arch, elevating a tail, shaping them however she likes.”
A LASH- AND BROW-GROWING SERUM
Enviably lush fringe and brows now possess such anti-aging power, topically-applied Latisse has become “a key element in eyelid rejuvenation,” says Biesman. “It’s highly effective at stimulating eyelash growth, and, for many, seems to work very nicely on the eyebrows, as well,” though brows tend to respond less predictably than lashes.
Its active ingredient is a prostaglandin analog that’s been used for years to treat glaucoma. When people began experiencing longer, darker, fuller lashes as a side effect of the drug—light bulb!—Latisse was born, though, exactly how it works to rev up hair growth is still unclear.
Another potential side effect you’ve, no doubt, heard about is an irreversible darkening of certain eye colors—but, according to Biesman, the risk is related to glaucoma drops only, not the paint-on form of the drug that is Latisse.
With the drops, 1 to 2 percent of patients with hazel eyes saw a darkening of their irises, however, with Latisse, “the amount of product delivered to the lashes is about 1/20th of what you’d get in an eye drop, and as of now, I’m not aware of any cases of eyes darkening from Latisse,” he says.
Latisse actually comes with a special applicator engineered to apply a safe and accurate dose. (Used as directed, the most common complaints are eye redness and irritation, and if spilled on skin, a slight staining, which can be undone.) With nightly use, new growth can be seen at one month, and the full effect at three.
A FUTURISTIC BAG SHRINKER
This fat-melting under-eye cream from Allergan is so ahead of its time, it’s not even FDA-approved yet—but it could be within the next year or so. While Allergan remains appropriately tight-lipped about the drug’s destiny, here’s what they will share: “Applied to the lower eyelids once nightly, XAF5 Ointment [what they’re calling the cream in clinical testing] penetrates the skin and acts pharmacologically on fat cells to shrink under-eye bags. In a Phase 2 randomized, placebo-controlled clinical trial, XAF5 met the primary endpoint achieving statistically significant and clinically meaningful reductions in under-eye bags.”
What might this mean for you? “If a topical fat-melting product were to be available and effective, it may help delay surgery temporarily or indefinitely for at least some individuals with lower lid puffiness,” says Biesman.