In recognition of National Eye Health Week later this month, Oculoplastic Surgeon and Facial Aesthetics Doctor Maryam Zamani breaks down and discusses the common eye concerns that she sees in her office. She describes the root cause, and her multi-level approach to optimise eye wellness.

Dark circles

Dark circles are a common complaint in my office and there are a variety of different reasons that they appear. Although getting enough sleep is very important for overall health and the appearance of skin in general, fatigue is not the main cause of dark circles.

The origin of dark circles can be anything from hereditary pigment changes, hyperpigmentation, poor circulation, hollowness or sunken appearance of the eyelids. One of the most common reasons is volume changes in the periorbital area. As we age, the eyelid-cheek junction becomes more prominent—where this junction was once confluent in youth, it becomes demarcated, giving the appearance of dark lower eyelids sometimes referred to as eyelid bags or dark circles. This can become quite evident even from our 20s and progresses as we age. As we age the facial skin and underlying structures begin to sag; this can be treated with meticulously placed micro droplets of hyaluronic acid to help hydrate and volumise the area, giving an immediate rejuvenating effect to the eye.

Another cause can be fat herniation in the lower eyelid, giving the appearance of dark circles. This can sometimes be masked with well-placed hyaluronic acid, but the gold standard is lower eyelid blepharoplasty. Blue reticular vessels or vascular lesions around the eye can contribute to dark circles. We all have these vessels, and we know that the periorbital skin is the thinnest on the body. Sometimes the blue discoloration can be seen through the skin, creating these dark circles.

Treating these periorbital and temple reticular vessels with a 1064 Nd:YAG laser (in 1-3 sessions) can achieve a significant improvement. Similarly, because the periorbital skin is so thin, a blue/red discoloration can be seen. In order to target this, I recommend treatments that help to boost collagen production. This includes skin boosters, polynucleotides or PRP to help boost collagen synthesis and thicken the skin.

Unfortunately, those with genetically or ethnically predisposed dark periorbital skin are harder to treat. Often long-term lightening creams, peels and lasers must be done with varying degrees of efficacy.” Hyperpigmentation from photo ageing can be treated with laser and light treatment, in conjunction with topical prescriptive treatments.
 

Impact of HEV light (high energy visible light)

Looking at computer screens for prolonged periods of time can cause squinting as well as frowning of the glabella, creating fine lines and wrinkles. Excessive screen time can also trigger digital strain resulting in dry eyes, eye fatigue, and difficulty focusing. There are studies which also suggest that chronic blue light exposure can damage retinal cells and contribute to age-related macular degeneration.

The jury is still out as to whether HEV light causes damage to the skin, and therefore one should always wear SPF. Using preservative-free artificial tears and taking breaks from the screen are important to help remedy dryness to the eyes caused by extreme screen time. Take a break every 15-20 minutes to look at a point in the distance and remember to blink! You can also use screen filters to decrease the amount of blue light emitted, and there are special glasses which are yellow tinted to block blue light. I also recommend decreasing screen time.
 

Periorbital ageing 

Swelling and puffiness around the eyes can be signs of ageing or other medical problems. With the ageing process, the skin, muscle and fat of the eyelids can change to form ‘bags’ under the upper and lower eyelids as well as excess skin causing wrinkling. In severe cases, the excess skin can obstruct the vision and give the sensation of heaviness of the eyelids.

Sometimes patients complain of extra skin draping over their eyelashes or difficulty reading. Eyelid surgery (known as blepharoplasty) is one of the most commonly performed cosmetic procedures to help rejuvenate the face. Blepharoplasty can remove excess fat, muscle and or skin to create a more youthful look. Eyelid surgery helps restore the function of the eyelids and the aesthetic appearance of the eye region.
 

Puffy eyes

The periorbital area, also known as the area around the eye, is particularly vulnerable to ageing. Eyelid skin is extremely fragile and thin, at only 0.05mm thick, and therefore the most delicate skin on our bodies. When you think that the underlying musculature (22 muscles and approximately 10,000 blinks per day) is under constant exertion, it is understandable that the eyes are prone to appearing more wrinkled. The periorbital skin also has fewer sebaceous glands, making it more prone to losing moisture and becoming dryer and, with time, there is a decrease in elastin and collagen production.

As we age, the bony structures below the skin also change, making it appear to age more quickly. External environmental factors like sluggish microcirculation can also exacerbate tired looking eyes, making them appear darker. Because of the thin overlying skin, markers for poor circulation are more prominently revealed around the eyes than on other parts of the body. The more dehydrated the skin around the eyes, the more tired and fatigued they appear.

There are many eye serums and creams that are available on the market as the periorbital area needs effective yet gentle treatment. Your regular daily facial serum or cream may be enough, however creams designed specifically for the periorbital area are preferable as they tend to be thicker than serums. These creams are formulated with active ingredients aimed for this delicate area, which help combat fatigue and signs of skin ageing.

It is important to note that with the application of eye products, the biggest mistake people make is that they apply the product too aggressively or they do not use enough. Also, many people forget to use sunscreen which is very important, as the periorbital area is extremely delicate and sensitive. When treating the periorbital area, it is important to look for ingredients that have potent antioxidants which protect from free radical damage and promote collagen production.

The answer to a more youthful complexion may not lie in simply focussing on the age lines, but rather on creating a more radiant and hydrated eye area. My professional approach is to maintain healthy, radiant skin with proper skincare to reveal, enhance and protect the face and the area around the eye. The more hydrated the skin, the less vulnerable we are to the signs of ageing.
 

What's next for eye tweakments?

There are so many exciting and new developments in both skincare and the world of aesthetics. My brand MZ SKIN is launching a new Microtox eye serum imminently, it will be a game changer for eyes! We know about all the neuro modulators and fillers but there is a new class of skin boosters using combinations of hyaluronic acid, vitamins and minerals, as well as polynucleotides to help rejuvenate and hydrate skin from within without creating volume.

Nucleofill is a relatively new injectable bio-revitalisation treatment that is safe on all skin types. Nucleofill is made from polynucleotides to deeply hydrate skin, promote collagen stimulation, and firm and contour the skin. It is an excellent alternative to dermal fillers as a bio stimulator of collagen production, rather than creating volume.