Under-eye issues seem to emotionally plague many of us, though not all of us intend to go under the knife. Still, if you feel like you need to do something, you're in luck. I reached out to oculoplastic surgeon Flora Levin and optometrist Jennifer Tsai with questions about non-surgical options for eye-area issues. My friend dermatologist Mary Lupo also weighed in with her favorite options for non-surgical treatments.
Get out your notepad, because here comes their advice, broken down by which particular eye-based issue is vexing you…
How can I fix dark circles and under-eye hollowness?
Under-eye darkness can be due to a few different factors. If you press on the dark area and it disappears, your issue is probably visible blood vessels below the skin. If the shadow doesn’t disappear with pressure, pigmentation is a likely culprit. Or there might be a shadow because of a deep tear trough or puffiness.
“Dark circles and hollowness are the most common concerns patients bring up,” wrote Tsai. For dark circles and discoloration, topicals alone rarely create dramatic change, she said. Retinoids have the strongest evidence, because they thicken the dermis and can diminish vascular show-through. Tsai does suggest that retinoids, vitamin C, and pigment-correcting serums can improve skin quality and discoloration over time. But don’t get spendy! No matter the price, neither a cream nor a serum will remove discoloration. “I always counsel patients that topicals are adjunctive, not corrective,” she said.
In a doctor’s office, treatment with intense pulsed light (IPL) and resurfacing lasers can brighten and thicken the skin — and in the right anatomy, injections of biostimulators or protein rich platelets (PRP) can reduce shadowing, said Tsai. (Please see Levin’s comments on this.) Mary Lupo likes to strategically inject a hyaluronic acid filler (Belotero) to reduce indentation, which can result in a lighter under-eye.
Lupo also had a couple of interesting observations and solutions about discoloration caused by allergies. Pop a Claritin and settle in:
"Many things could contribute to discoloration, number one simply being the result of sun exposure and aging, which may be improved over time by the use of gentle topicals [mentioned above]. Often, however, discoloration is really from something called lichenification, due to chronic rubbing.
"I see this a lot in people with eye allergies, and people who tend to rub the skin around their eyes. Rubbing actually thickens the skin, as well as increases the amount of pigmentation, and the skin can get sort of a dark, leathery appearance. For this issue, use soothing and hydrating ingredients and perhaps even botanicals that are anti-inflammatory like chamomile, etc. Plus, try to break the habit of rubbing your eyes.
"Then there’s the bluish hue under eyes caused by venous congestion, which occurs when you have chronic sinus problems. Diminished venous drainage in that area results in the discoloration. I tell my patients to use a preservative-free eye wash twice a day to get pollen and other irritants off the eyelashes and out of the eyes, along with a preservative-free saline wash or Navage-like irrigation product to flush the sinuses. And I recommend a solid month of using an antihistamine like Xyzal at bedtime and Claritin D in the morning to determine if that diminishes discoloration."
Lichenification! Beautiful (and fascinating) on a rock. Under your eyes, not so much.
I hate my droopy eyelids
“Droopy upper lids and hooding are very common with age,” said Tsai. “In early stages, Upneeq eye drops can provide a temporary lift by stimulating the Muller’s muscle and opening the eye. Non-surgically, radiofrequency (RF) and ultrasound can tighten mild laxity, and neuromodulators can optimize brow position, which can all help with early heaviness.
“But with RF and ultrasound, outcomes are variable and highly dependent on patient selection, device choice, and treatment parameters. I’m very cautious about recommending them as a primary solution for significant laxity,” she said.
Diminishing excess skin requires upper lid blepharoplasty, as most of us now know. And please note Tsai’s use of the adjectives “mild” and “early.”
What can I do about under-eye bags?
“Under-eye bags are common and their appearance often fluctuates,” said Tsai. They can be caused by fluid retention and allergies, or by protruding orbital fat and thinning skin.
At home, using cold compresses, antihistamines, and nasal steroids, and keeping your head elevated at night in bed can all temporarily reduce swelling, depending on the cause, said Tsai.
Here, I’ll reiterate that I happen to like undereye bags; I think it may be because they’re prominent in my family and I associate them with older relatives who were uninhibited about loving on me.
How to get rid of fine lines
“Fine lines and crepey texture respond very well to treatment,” said Tsai. At home, retinoids and creams containing peptides and growth factors may improve skin quality. But again, keep your hopes in check: Significant improvement in heavily-lined skin is unlikely (er, impossible) with topicals.
In-office treatments like resurfacing lasers and neuromodulators can significantly smooth fine lines, said Tsai. So if it’s fine lines that bother you, you’re in luck: They’re the easiest to treat non-surgically. Which isn’t to say you should downplay preventative care. So to echo what you've heard one billion times before: Sunscreen, sunscreen, sunscreen.
I have a bottom-line to all this advice: When you want a lasting, visible difference for eye issues, most often nothing works as significantly as an in-office treatment. But if you do call a dermatologist or plastic surgeon for a consultation, be sure to ask if there’s a fee.
But before you go, here's another big question you might want to ask (yourself): Are you absolutely sure it’s your lovely face you’re unhappy with?
Reprinted with permission from the weekly Substack newsletter How Not to F*ck Up Your Face. Go to valeriemonroe.substack.com to take advantage of a limited-time, half-price sale. From now until May 31 at midnight EDT, you can subscribe to HNTFUYF for $25/year. That gets you full access to all posts, an extensive archive of more than 250 beauty Q&As, and personal responses from Val.
Val Monroe spent 16 years as the beauty director at O, The Oprah Magazine and has been an editor at Ms., Redbook, Self, and Parenting magazines, among others, a contributing writer at Parents, Entertainment Weekly, The Cut at New York Magazine, and has written hundreds of articles for national publications; she’s currently a contributor at Allure Magazine.
