It’s true that our delicate, thin-skinned eyes are first in line when it comes to making us look stressed, exhausted, or older than we feel. But this can be due to multiple reasons that all have their own causes and complications: think dark circles, eye bags, crow's feet, hollowness under the eyes, droopy eyelids... the list goes on.

Unfortunately, in an aesthetics world dominated by the ‘latest’, ‘best’ and ‘trendiest’ options, both clients and practitioners risk diagnosing the wrong issue and seeking, or prescribing, the wrong treatment for the purpose. Much as we’d all like a one-size-fits-all ‘miracle’ eye tweakment, such a thing doesn’t exist, and in the case of eyes more than anywhere else, it is imperative to seek a consultation with a medical specialist versed in a wide palette of targeted treatments.

 “It’s important patients go to a medical practitioner with experience in non-surgical and surgical peri-orbital treatments,” adds Oculoplastic Surgeon, Mrs Sabrina Shah-Desai. “The eye area anatomy is challenging and very delicate and requires proper assessment to avoid complications.”

That said, some guidance can certainly be given about the types of treatments considered ‘gold standard’ for each issue. We asked the experts for their best-practice advice.

Dark circles

Dark circles can be caused by pigmentation or by blood vessels becoming visible under thinning skin, but, says Shah-Desai, “in most cases both of these components are involved, so I rely on two go-to treatments that tackle both issues.

One is Tixel Glow, which uses heat energy delivered by miniscule cones on a handpiece. They painlessly puncture tiny channels through the skin barrier, allowing for active treatment products to penetrate to the dermal layer where they can effectively do their brightening work.” The controlled damage, she says, also helps plump up the skin volume in the area.

Other benefits are that you can use the technology right up to the lash line, and it’s safe for darker skin tones. “Patients need to combine it with consistent use of an eye cream containing key brighteners and collagen boosters: vitamin C, caffeine, arbutin and peptides, plus daily undereye SPF,” she adds.

Intense Pulsed Light (IPL) combined with topicals works along the same lines and can be very effective, although you can’t get as close to the eyes as Tixel can. But it’s only suitable for light to medium skin (darker skin tones risk burns) and, warns Shah-Desai, “get it done near the eyes by an experienced dermatologist and not a beauty therapist."

For a slightly ‘softer’ option, Holistic Skin Expert, Gemma Clare, is a fan of microneedling mesotherapy. “I use SkinPen, an FDA-approved precision microneedling device that can be used inside the orbital area (using a shorter needle length). It induces both collagen production and microchannels in the skin, so that the SkinGenuity Growth Factor Serum I follow it up with can do its work in the deeper dermal layers. It’s a short procedure with very little downtime that in my experience improves dark circles, alongside crepiness and mild eye bags – if it’s followed up with the right skincare and the right lifestyle strategies. It’s safe for all skin tones.”

Crow’s feet

Possibly the least problematic of all eye ‘issues’ to solve, crow’s feet can be treated and very much softened with toxin injections at the outer eye corners. Lines and crepiness under the eyes are definitely not candidates for muscle relaxant injections, though.

Undereye crepiness and laxity

“This all depends on depth of the lines and level of sagginess,” says Shah-Desai. “For mild textural issues (think little lines that deepen when you smile), which may or may not be accompanied by volume loss under the skin and below the muscle, expertly placed fillers are ideal. They will support the muscle and skin and so smooth out the texture, while hydrating the area as well.”

According to Shah-Desai, it’s a different story for the over-45’s, though. “Generally, around this age, the wrinkles and cross-hatching are too severe for fillers to ‘sit’ well; they could end up looking lumpy. This is when I look to the more intense energy-based devices to rev up collagen production and smooth out and tighten the area.”

Ablative (ie, removes a layer of skin) Tixel is the best option here, she finds. “It’s more intense than non-ablative Tixel Glow and does cause temporary swelling and micro-crusts, but it’s still a vast improvement on the downtime and side effects of ablative laser treatments, and you can work right up to the lower and upper lashes.”

If there is moderate sagging on top off the cross-hatching, “I prefer Morpheus8; it delivers intense subdermal radio frequency heat through microneedles. This doesn’t just smooth texture but can visibly tighten and lift skin,” says Shah-Desai. There will be swelling and bruising, though.

For those for whom the concept of ‘controlled damage’ (i.e, causing injury in order to get a rejuvenating healing response) is an anathema, there are softer options here. Results won’t be as dramatic and take longer to become apparent, but there is no risk of complications or potentially damaging and ageing inflammation.

Consultant Oculoplastic Surgeon Mrs Rachna Murthy, recommends Revision Skincare Revox 7 Serum. “Clinically proven topicals should always be in the mix, and this serum has clinical levels of peptides that minimise micro-contractions in the skin,” she says. “It visibly softens crepiness and crow’s feet.”

Facial Skin Aesthetics Clinical Director, Julie Scott, likes to upgrade the benefits of topicals with a skin booster such as Teosyal Puresense Redensity-1, injected into the skin around the eyes in small droplets: “its high molecular weight hyaluronic acid and 14 nutrients work to noticeably improve texture, tone and laxity,” she says.

“It’s even better combined with Endymed iFine, which I favour for delivering targeted radio frequency (RF) energy to the eye area. This type of multi-polar RF is painless and suitable for all skin tones, comfortably heating the deeper skin layers to stimulate collagen production and tighten skin over the course of regular [usually six] sessions.”

Undereye bags and puffiness

“Mild bags are candidates for undereye and tear trough fillers,” says Shah-Desai. “If the swelling is relatively minimal and the hollows are actually more significant than the bag, then expertly judged filler in the right places can smooth the area out.”

If the issue is primarily with a prominent bag, or you’re dealing with malar bags or festoons (swollen mounds on the lower eyelid, just above the cheek), filler will make the situation worse – another reason to make sure you get a thorough consultation with an eye area expert.

“In these cases, you need to be looking at surgery,” says Shah-Desai. “Alternatively, Morpheus8 can bring improvement in tightening moderately baggy skin, but results can be variable and are temporary, so you need to make an informed decision on whether it’s worth it.”

A course of treatment can easily set you back £3000 while lower eyelid blepharoplasty (eye bag surgery) starts anywhere from £2000-£6000, so this indeed warrants careful weighing up of options.

A ‘soft’ option for eyes that seem puffy and tired all the time is a multi-pronged lymphatic drainage and lifting facial treatment.  “When targeting puffy eyes, galvanic currents to cleanse and smooth the delicate eye area skin, vacuum suction for de-puffing, lymph drainage and waste elimination, microcurrents to reprogramme muscle fibres to contour and tone, iontophoresis to drive specific active ingredients into the skin, and Dermalux LED phototherapy to rejuvenate and calm, work a treat," shares Clare.

Crepey and saggy upper eyelids

“Mild excess skin on the upper lids – manifesting as crepey skin that’s beginning to look baggy – can be effectively treated with the Plexr nano plasma pen,” says Shah-Desai. The pen vaporises tiny dots of eyelid skin in a grid pattern; over time the skin will contract and lift the lid. “It’s a temporary solution, though, and the downtime can be significant, so here again it’s often worth considering surgery as an alternative,” says Shah-Desai.

Murthy agrees: “I have seen a lot of unpredictable inflammation, significant swelling and downtime with little improvement when compared to post-surgery recovery (two weeks or less) happen in people who had Plexr,” she says.

“With this in mind, I would suggest upper eyelid blepharoplasty can be far less traumatic, and significantly more long-lasting. The procedure is quick and takes place under local anaesthetic; personally, I would class it as a ‘tweakment’ despite the use of scalpels.” Murthy is a fan of tweakments that limit the amount of trauma and ‘controlled damage’: “too much damage and inflammation on a regular basis is, frankly, just damage, and counterproductive when it comes to the ageing process.”

Undereye hollowing

“Hollows do well with fillers, whether they be fat or dermal fillers,” says Shah-Desai. “The risk with hyaluronic acid-based dermal fillers is the delayed swelling in some patients: it happens particularly in those with allergies [some see their fillers temporarily inflate off and on, creating a sort of transparent ‘pillow’ effect - it can go on for many years].

The best way to avoid it is to accept subtle improvements from your filler treatment, as opposed to ‘Adobe Photoshop’ results. You should also increase the time between top-ups – don’t request them twice a year, as some people like to do.” The swelling can be conservatively managed, she says, with massage, anti-allergy pills or steroids.