(Now Let’s Talk About How We Can Keep Them Looking Great!)

The eyes are central to communicating how we feel. It’s an area that is very delicate, and changes in the skin and underlying structures around the eyes can have a profound effect on how we see ourselves and how others see us. When you look or feel sad, tired or mad, it’s usually the eyes that show it first: signs of joy, love and even wisdom, but also the telltale signs of a tough day or a tough year. The good news is there’s so much that can be done to help your eyes look their best at every age!

The Physical Structure of the Eye

To understand eye aging, you have to understand its physical components. Deep under the skin is a framework of bone and a socket or hole surrounded by muscles, ligaments, fat pads, lymphatics, nerves and blood vessels that hold everything together under and to the skin. Each layer and element is very important in helping you see, blink, and protect your eyes and vision from harm. They are also critical to how you look and how we rejuvenate the area using aesthetic treatments. The aesthetic physician must carefully investigate the source of each issue before treating, and it is important to understand it often takes a combination of skin care, devices and sometimes injectables for optimal, natural and lasting results.

Common Complaints

The most common complaints I hear about the eyes are dark circles, under eye hollows or bags, crêpey skin, wrinkles, the drooping of the lids and the thinning of lashes and brows. It’s a long list for such a small area of the body: it certainly speaks to the power of the eyes in beauty! So where do we begin? Let’s discuss each concern step-by-step.


They’re the most obvious signs of lack of sleep, one too many cocktails and stress: those hazy, brownish-bluish-purplish clouds underneath your eyes can be hard to conceal and are among the most common concerns my younger patients have. What gives the skin under your eyes its color is a combination of blood vessels, pigment in the skin, and the thickness of the skin along with fluid that can accumulate in this delicate, sensitive area.

  • Not enough sleep. Solution, sleep more. Try listening to ocean sounds at bedtime, taking deep breaths and allowing yourself to let go. We all go through difficult times where we can’t sleep, but it’s not sustainable to not get enough sleep over a long period of time. Cat naps can help too.
  • Not enough water. Solution: drink more water. You can also eat your water since many fruits and vegetables contain up to 90% water and thankfully that counts towards your needed daily intake.
  • Too much alcohol: this leads to both dark circles and puffiness. Try drinking less and see how magical it is for your eyes. You’ll also lose a few pounds and feel better. All round a win-win situation!
  • Allergies: dark circles are often a combination of both pigment making the skin darker and redness from dilated blood vessels. Allergies cause increased redness through the latter effect and rubbing will lead to darkening through increased pigment from the irritation. Solution? Try to stay ahead of allergies. If you know when they start try taking allergy medicine a week or so before they start or speak with your allergist about how to avoid falling behind and having symptoms that are difficult to control.
  • Rubbing: Every day I see women aggressively touching and rubbing their eyes.  It’s one of the worst things you can do to the delicate skin in this sensitive area. Just don’t do it. Try gently patting on a moisturizer instead.
  • Genetics: Sometimes this is the cause and while you can’t control your genes, you can take great care of your genetics. This means don’t rub your eyes, wear sunscreen and sunglasses and use excellent products that will keep the eye area as healthy as possible. I really like eye creams that have ingredients like niacinamide, vitamin C, growth factors, peptides, caffeine and retinol.

Makeup is a temporary fix. Don’t pile on heavy concealer, it can settle into fine lines and actually makes them look worse. Instead, try a highlighting pen, which reflects light and immediately brightens the under-eye area. If you need more coverage, layer a more opaque cream concealer on top but be sure to warm up the product first on the back of your hand so it blends in perfectly.

Treatment Options:

In-office treatments such as peels, lasers, devices that tighten, and fillers are sometimes needed and can have a lasting effect. This is a very sensitive and delicate area and most of these treatments, especially fillers, should be done or supervised by a trained aesthetic physician.

Before and After. Compelling and natural results are possible with the right eye rejuvenation.


The under eye area is one of the most sensitive and delicate areas of the body and it’s often abused. Every day I see women rubbing and aggressively touching their eyes. It hurts to watch! Rubbing creates a defensive response of the skin which leads to thickening, wrinkling and dark circles. Another issue in this area is puffiness. Puffiness can have several causes and one is fat pad herniation which is usually a genetic problem. A quick test I use in the office is to press on the upper eyelid. If I see a bulge in the lower lid, then I know it’s a fat pad issue. If I don’t see a change it’s more likely to be fluid and controlling salt and drinking more water should help a lot.

Treatment Options:

The injection of soft tissue fillers in the midface can help soften the look of a bulging fat pad under the eyes, but it has to be done carefully or it could make the eyes look smaller and make the pads look worse and can leave a bluish tint to the skin. Often the best solution is surgery to reposition the fat pad.

For under eye hollows fillers can be very helpful, but the lower eye lid is not usually the best area to treat first. It is important to evaluate the midface as well and it often helps to add volume in specific areas of the midface to improve under the eyes. This is an area for advanced injectors and an area that needs extra-careful consideration to avoid complications!


When I get professional make up done for TV or a special event, the make-up artist spends the most time on the eyes, making them “pop.” It makes perfect sense. Having big beautiful eyes, of any eye color and smooth even skin tone around the eyes is a sign of youth, calm and confidence.

Treatment Options:

The best treatments for improving the skin are the skin care ingredients I mentioned above under ‘Dark Circles’, neuromodulators like Botox, Dysport or Xeomin for smoothing the lines and preventing them from getting worse, fractional laser care to rejuvenate the skin and finally devices that use radiofrequency or ultrasound energy to tighten and lift the skin and address the skin’s deeper layers.  Our latest non-surgical Eye Lift addresses many of these issues in unison to create comprehensive improvement! The result is beautiful, youthful, natural eyes that maintain their shape and are a true reflection of you.


Drooping or heaviness of the upper lids can be genetic or it can come from lifestyle factors like sun exposure. It can start as early as in your 30’s and there are now excellent non-surgical options, especially if you start early!

The heaviness of the lids and drooping of the brows causes an additional problem because the normal reflective response is to raise the brows to lift the lids and this creates forehead wrinkles. Many if not most forehead lines are not due to primary wrinkling of the forehead itself but rather as a secondary effect of heavy eyelids. If we add Botox to the forehead we can easily eliminate the lines there, but the tradeoff is that it makes the eyelid problem worse because now the forehead muscles are weakened and can’t lift the brows and the brows can’t lift the lids as effectively. It makes one problem better but without treating the source it makes another issue worse!

Treatment solutions:

The best non-surgical solution is to lift the brows with a tightening or lifting device like Ultherapy, Thermage or Endymed Tightening. A little Botox works great to soften the forehead movement without creating a negative effect on the eyelids.


The brows frame the eyes and create the balance for the upper face. They can thin and droop over time although for a good number of women the brows go up not down as they age. For thinning brows I like minoxidil to help grow them out: it creates beautiful results and is very well tolerated.

Treatment solutions:

Strategically placed neuromodulators can help make the brows even in height, and give them a nice arch. Tightening and lifting devices helps situate them just where they need to be to help your eyes look their best. As they go gray they can also be tined and dyed. Micro blading (similar to tattooing) can be used to add color and give the illusion of increased volume!

Interested in eye rejuvenation? Learn more about our Eye Lift here.

Our Medical Aesthetician, Holly Montgomery, performing part of our proprietary Eye Lift treatment.