Understanding Periorbital Aging
The periorbital area undergoes noticeable changes as a person ages. These changes are influenced by a combination of intrinsic factors (genetics, natural aging process) and extrinsic factors (environmental, lifestyle, and behavioral factors). These are the common changes in the periorbital region with time:
Loss of Skin Elasticity
As we age, the production of collagen and elastin in the skin decreases, leading to a loss of skin elasticity. The skin around the eyes becomes thinner and less firm, resulting in fine lines, wrinkles, and creases, particularly around the corners of the eyes (crow's feet).
Wrinkles
Repetitive facial movements, such as squinting, smiling, and frowning, can lead to the formation of dynamic wrinkles, especially around the eyes where the skin is thinner and more delicate.
Drooping Eyelids and Brows
The weakening of the muscles and tissues that support the eyelids and brow can lead to drooping, hooding, and sagging of the upper eyelids and eyebrows. This can impair vision (known as medical ptosis) and contribute to a tired or aged appearance.
Volume Loss
Loss of subcutaneous fat and soft tissue in the periorbital area can lead to hollowing or sunken appearance around the eyes. This can result in the development of tear troughs, dark circles, and a tired or aged appearance. Changes in bone structure and density due to aging can also affect the appearance of the periorbital area. Bone resorption around the eye socket may contribute to a sunken or hollowed appearance, particularly in the upper and lower orbital rims.
Puffiness and Swelling
Fluid retention and weakening of the muscles and tissues around the eyes can contribute to puffiness, swelling, and bags under the eyes. This can be exacerbated by factors such as fluid imbalance, allergies, lack of sleep, and dietary habits.
Skin Texture Changes
The texture of the skin around the eyes may become rougher, drier, and more prone to uneven pigmentation as a result of cumulative sun exposure, environmental damage, and decreased skin cell turnover.
Unhealthy lifestyle habits, such as smoking, excessive alcohol consumption, poor nutrition, chronic exposure to UV radiation and inadequate skincare, can accelerate the aging process and contribute to the development of premature signs of aging in the periorbital area. However, even with our best efforts, the aging process of the periorbital area is multifactorial. This is also why doctors have a variety of treatment options to help combat signs of aging in the periorbital region.
Treatment Options for Periorbital Aging
PDO Lift (PDO Thread or PDO-200 Liquid Thread Treatment)
Thread lifts can be strategically placed along the brow bone to lift and reposition the eyebrows, addressing drooping or hooded eyelids. By creating tension under the skin and lifting saggy tissue and brows, the eyes appear more open, alert, and youthful, reducing the appearance of tiredness or heaviness in the upper eyelids.
Thread lifts not only lift and tighten the skin but also stimulate collagen synthesis in the treated areas. This is how “liquid threads”, or simply, a liquid form of threads, work. They stimulate collagen without the downtime and discomfort of inserting a thread under the skin. Liquid threads are injected with minimal downtime, and over time, the increased collagen production leads to improved skin texture, elasticity, and firmness around the eyes, diminishing the appearance of thin skin and enhancing overall skin quality.
PDO Lift treatments can be done as a simple minimally-invasive office procedure with topical anaesthesia. Risks involved mostly involve some discomfort, bruising or swelling post-procedure, and are temporary. PDO Lift treatments are meant to refresh and enhance one’s natural features and beauty regardless of one’s age, and are not meant to look “fake” or artificial.
Botulinum Toxin
Botulinum toxin is a neurotoxin that is widely used in medical aesthetics to reduce the appearance of wrinkles and fine lines caused by muscle movement. One of the most common uses of botulinum toxin in the periorbital area is to soften the appearance of crow's feet, which are the fine lines and wrinkles that form at the corners of the eyes when smiling or squinting, resulting in a more refreshed appearance around the eyes. Botulinum toxin can also be strategically injected into certain brow muscles to create a subtle lifting effect.
Botulinum toxin injections are FDA-approved and have been extensively studied for their safety and efficacy. When administered correctly, botulinum toxin injections can provide natural-looking results that preserve facial expression and movement. The goal of treatment is typically to soften wrinkles and lines while maintaining normal facial expressions.
PDRN Skinboosters (Rejuran-I Treatment)
PDRN (Polydeoxyribonucleotide) skinboosters are used to improve skin quality, hydration, and overall appearance of the skin. They contain a high concentration of hyaluronic acid and nucleotides, which are the building blocks of DNA. When injected into the skin, PDRN skinboosters stimulate cell regeneration, collagen production, and tissue repair, resulting in smoother, firmer, and more radiant skin.
PDRN skinboosters help to improve skin texture in the periorbital area, including skin hydration levels, and the appearance of fine lines, dry skin and dark eye circles. By increasing collagen synthesis, PDRN skinboosters can also help to improve skin laxity and reduce the appearance of fine lines and wrinkles around the eyes.
PDRN skinboosters can benefit individuals of various ages and skin types, not just those with mature or aging periorbital skin. They are often used as a preventive measure to maintain skin health and vitality, as well as to address early signs of aging.
PDRN skinbooster treatments are generally well-tolerated and involve minimal discomfort. The procedure typically involves a series of small injections into the skin, which may cause slight stinging or discomfort that is usually brief and tolerable. There is typically little to no downtime associated with PDRN skinbooster treatments, and most individuals can resume normal activities immediately afterward. Some mild swelling, redness, or bruising at the injection sites may occur but usually resolves within a few days.
Plasma Energy (Neogen Plasma Treatment)
Plasma energy works by delivering controlled heat energy to the deeper layers of the skin, stimulating collagen and elastin production. The heat energy stimulates collagen remodeling, which leads to the gradual reduction of wrinkles and the promotion of smoother, more youthful-looking skin. The skin tightening and lifting benefit of plasma energy can also help to reduce the appearance of sagging skin around the eyes.
Plasma energy treatment is a non-invasive treatment that can be done safely in the periorbital region, including the upper eyelid, where skin is especially delicate and thin.
Ultrasound Energy (Ultherapy and Sofwave Treatment)
Ultrasound treatments such as Sofwave and Ultherapy are non-invasive procedures that utilize focused ultrasound energy to improve the appearance of the skin. Both Ultherapy and Sofwave are FDA-approved treatments that have been clinically proven to be safe and effective for skin tightening and rejuvenation.
Ultrasound energy penetrates deep into the skin layers, targeting the deep dermis and the superficial muscular aponeurotic system (SMAS). By delivering focused heat energy to these layers, ultrasound treatments stimulate collagen production and remodeling. This results in tighter, firmer skin around the eyes, reducing the appearance of wrinkles, fine lines, and sagging. In addition, ultrasound energy can also stimulate lymphatic drainage and improve circulation in the periorbital area, reducing fluid buildup and puffiness under the eyes, resulting in a brighter, more refreshed appearance.
Laser Energy (Yellow Laser Treatment)
A yellow laser wavelength, typically in the range of 577 to 595 nanometers (nm), is often used in medical aesthetics for various skin concerns, including concerns in the periorbital region. In the periorbital area, conditions such as broken capillaries may contribute to redness or discoloration. The yellow laser selectively targets the hemoglobin in these blood vessels, causing them to coagulate and eventually be absorbed by the body, resulting in a reduction in redness and vascular lesions.
The yellow laser wavelength can also address certain pigmentation concerns around the eyes, such as sunspots, age spots, and freckles, and promote collagen production and skin rejuvenation in the periorbital area. The laser energy penetrates into the deeper layers of the skin, stimulating fibroblast activity and triggering the production of new collagen and elastin fibers. This helps to improve skin elasticity, firmness, and texture, reducing the appearance of fine lines, wrinkles, and crepiness around the eyes.
Doctor’s Perspective:
The periorbital region is a common presenting complaint or reason for encounter among patients in my aesthetic practice. It is clear that societal norms and our individual standard of beauty regard the eyes and periorbital region as an essential trait of ourselves and an extension of our personality and beauty. With a whole gamut of options available, ranging from surgical to minimally-invasive or non-invasive, from machines and devices to new and upcoming skin-improving cocktails, it’s important to understand why your doctor may prescribe you certain treatments or a variety of treatment in his or her attempt to meet your concerns or expectations.
Finally, eye health is just as important - from relaxing those wearied eye muscles from the constant glare of devices and screens to resting puffy eyes due to poor sleep or dietary indiscretions - lifestyle habits play a role in maintaining good eye health and sleep hygiene and let’s not neglect these, too.
Medically reviewed by Dr. Harold Ma and Dr. Joanna Chan.