How to Address The 6 Most Common Aging Eye Concerns

Year over year of aesthetic data shows tweaking our eyes—through surgery, injections, energy-based treatments and eye creams—is a top priority. It’s easy to see why, with eyes serving as windows to the soul. Factor in pandemic-era considerations, including eyes-only exposure when making face-to-face contact and countless Zoom meetings, and the condition of skin around our eyes suddenly comes into razor-sharp focus. How to best address drooping eyelids, fallen browlines, and hollowed or puffy skin? As the experts share, the optics have never been better.

The Concern: Uneven Eyelids

THE CAUSE: From birth, everyone has some degree of asymmetry between eyelid creases, says Woodbury, NY oculoplastic surgeon David Schlessinger, MD, though the aging process can make these differences more pronounced. While less common, some cases of asymmetrical creases are caused by ptosis, trauma and eyelid surgery.

THE FIX: “For actual crease differences I think surgery is the best solution,” says Dr. Schlessinger. According to the surgeon, eyelid crease revision is the best option to address an imbalance from one eyelid crease to the next, correct outcomes of a previous eyelid surgery, or to create a double fold, when desired. “During the procedure, extra skin is removed and then sewn in a specific way to form an adhesion between the skin and the underlying muscle and create a new crease in the desired location,” notes Dr. Schlessinger. Results are typically permanent with minimal downtime: “Sutures are left in place for about a week. Patients can return to normal work afterwards.”

The Concern: Droopy Upper Eyelids

THE CAUSE: Known as blepharoptosis, the fall of upper eyelids is commonly due to genetics and aging, though as New York oculoplastic surgeon Irene Gladstein, MD points out, this phenomenon can also occur as a sign of disease in the body, so it’s important that physicians look for and medically manage these causes before applying aesthetic solutions.

THE FIX: After ruling out underlying health issues, doctors may suggest a blepharoplasty, in which excess skin, muscle, and fat are removed and reshaped in order to give eyelids a lifted effect. If the dropping lids are connected to muscle ptosis (or the change in a muscle of the upper eyelid) nonsurgical options can also be explored. “Upneeq [an eye drop that can raise eyelids for up to six hours] is best used for patients with mild cases of acquired ptosis,” says Dr. Gladstein. “It’s a good alternative for those who are not yet ready for surgery.” Those with mild eyelid hooding can also benefit from Plasma Pen skin-tightening (although long-term evidence is needed). “Only trained eye professionals are able to approach the delicate skin around the eye with the needed knowledge and expertise,” she explains.

The Concern: Fine Lines

THE CAUSE: Aging and lifestyle choices like smoking and sun exposure.

THE FIX: Blepharoplasty effectively smooths fine lines. But for a noninvasive way to tighten skin around the delicate eye area, Greenwich, CT dermatologist Lynne Haven, MD favors the resurfacing power of Thermage. “It is FDA cleared for the eyelids, is very safe, requires no downtime, and gives natural-looking results because it uses your body’s own collagen to do the tightening,” she says. Although more data is needed, Dr. Haven also has her eye on a recently FDA-cleared, but not yet commercially available, needling technology called micro-coring for tightening skin nonsurgically.