Eye Area Problems - Wrinkles
What are wrinkles?
Facial wrinkles are the creases that develop from:
1) sun damage and the natural ageing process, and
2) years of squinting, frowning, smiling and laughing (often amplified in smokers).
Every movement of the face affects the collagen fibres in the skin. The deepest wrinkles are usually found between the eyebrows and on the bridge of the nose. Other wrinkles tend to appear on the forehead and around the eyes. Squint lines just beside the eyes are known as 'crow's feet'. Sleep lines can also develop if you sleep in the same position on the pillow every night. On women, these lines tend to appear on the cheeks and chin whereas men usually develop them on their foreheads.
Aside from making you appear older, deep wrinkles can also give others the impression that you are constantly sad, angry or afraid. Certain treatments exist that can restore a more youthful appearance allowing your outward expressions to match your feelings more closely.
What preventative measures are recommended?
The best way to prevent wrinkles is to protect your skin from sun damage. Appropriate measures include wearing protective clothing, sunglasses and sunscreen when outdoors. One should also refrain from smoking as squinting from smoke exposure increases the likelihood of severe wrinkling in this area.
Vitamin C in the form of L-ascorbic acid stimulates the body's production of collagen, an essential building-block of healthy skin. It has been found to prevent the formation of wrinkles around the eyes and, if wrinkles already exist, to assist in their resolution. Similar preventive effects may occur with other antioxidants such as other vitamins and related agents.
What are the available treatments?
Topical options
The following options are suitable for the treatment of fine lines around the eyes and are generally best used in combination.
Several different alpha-hydroxy acids (AHAs) are used to diminish the appearance of fine wrinkles. These include glycolic acid, citric acid (vitamin C) and lactic acid. All of these work as effective exfoliators and contribute to rejuvenating the appearance of the skin around the eyes. Low concentrations are preferred because the skin around the eyes in extra sensitive. High concentration AHAs may leave the skin dry or irritated.
Vitamin A creams come in two main types based on their respective active ingredients: retinol and tretinoin. The former does not require a prescription but the latter does. Tretinoin is ten times stronger and, as such, retinol is more appropriate for those with sensitive skin. It should be noted though that dryness, redness and increased sensitivity to the sun can still arise from retinol-based products.
Another option is a product called kinerase which contains a plant growth hormone called kinetin. It has been shown to have similar results to tretinoin-based products but without the associated drying effect.
Vitamin C-based products have been suggested to have both protective (antioxidant) and rejuvenating qualities. Those containing a particular compound of vitamin C, L-ascorbic acid, are particularly effective because they stimulate the skin's own production of collagen - a primary component of healthy skin.
Products containing copper peptides are also considered to be beneficial for the reduction of fine lines.
Products should not be applied to the upper eyelids unless directly specified by your health care professional.
Available procedures
Photomodulation is an interesting new modality that can be used around the eye. It works by activating the skin cells with pulses of non-thermal light. The skin cells then convert light energy in much the same way that plants convert sunlight into food energy in the process of photosynthesis. The light triggers the skin cells around the eye to function as they did when they were younger. As such, it can effectively reverse the appearance of sun damage and other signs of ageing. The skin often continues to improve several months after treatment. This technique has been found to be particularly advantageous when preceded by a specialised course of vitamins, antioxidants and nutrients.
Photorejuvenation is another light-based treatment. It delivers stronger pulses of light deep into the innermost layer of skin, injuring then repairing its collagen. A course of several sessions, each a few weeks apart, is typically recommended for best results. It is difficult to improve the wrinkles in the eyelid area with this technology as the eye itself needs protection during these treatments, limiting its use close to the eye. On the other hand, dermatologists may choose to combine photorejuvenation with other procedures such as laser resurfacing, and muscle relaxant injections. While muscle relaxant injections don't improve the discoloration, they may be used to help smooth wrinkles, complementing the patient's final result.
Laser stands for 'Light Amplification by the Stimulated Emission of Radiation'. Functioning either surgically or non-surgically, a laser works by directing an intense beam of light in one direction. The beam is controlled according to the intensity and colour (wavelength) required for the specific purpose. The newer lasers achieve the highest degree of safety due to their outstanding precision.
Laser resurfacing is used to effectively treat skin damage and improve the skin's tone and texture. Unwanted facial wrinkles such as crow's feet around the eyes, smoker's lines and frown lines are softened or removed entirely using a wand-like laser handpiece. This treatment is also an effective means of smoothing and tightening eyelid skin. Favoured for its precision and safety in treating delicate areas such as the skin around the eyes, laser resurfacing is also safe and involves relatively little bleeding. It can be used as an alternative or complement to other skin rejuvenation procedures mentioned earlier.
Plasma skin resurfacing is also a useful new treatment whereby an energetic cloud of plasma, comprising freed electrons from nitrogen atoms, is absorbed by the skin. This allows for an easier healing phase than that of laser resurfacing and has a highly beneficial effect on eyelid wrinkles.
Fractional resurfacing is an alternative, non-invasive laser procedure that is computer assisted to accurately read the face's contours. It rejuvenates the skin in a similar manner to photorejuvenation and can also be used for pigment and texture irregularities. It should be noted, however, a course of treatments is required.
Muscle relaxant injections
Treatment of sleep lines, expression lines and deep wrinkles focuses on ensuring that the skin is kept relaxed. To accomplish this, dermatologists often recommend the use of muscle relaxant injections for rejuvenation whereby a small amount of muscle relaxant is injected into the facial muscles causing them to relax. It works by blocking the movement of nerves to particular facial muscles, causing them to become inactive. The line then becomes smoother as the skin stretches out, uninhibited by any muscular pull. Care is taken to ensure that a natural expression is maintained. To achieve the best results, muscle relaxant injections are often combined with dermal fillers, laser resurfacing or chemical peels.
The procedure reduces the appearance of wrinkles around the eyes, such as crow's feet. Safe and non-invasive, it doesn't necessitate any recovery time. Effects are noticed within a week of treatment and generally last between three and four months, fading as the muscle action returns. Even after the actual effects of botulinum toxin are gone, the lines remain shallower and less severe from not having been contracted. After several treatments, the muscle may also start to become less active, causing the results to last longer.
Side effects are rare, minimal and generally only include minor bruising or soreness from the injection itself. Otherwise, in rare cases, the neighbouring muscles may become weaker resulting in a temporarily droopy eyelid or brow. All of these potential side effects are self-limiting, minor, and reversible.
Wrinkle fillers
Fillers serve to replace the underlying fat and collagen that is lost in the natural ageing process - one of the main causes of wrinkled and saggy skin. The other treatments mentioned above can improve the skin's texture and tone and reduce the appearance of wrinkles. However, only fillers can address the loss of facial volume that ageing brings.
A wide range of fillers exists but successful treatment depends upon matching the right filler to the individual's situation. Some fillers are intended for deep wrinkles and others for more subtle wrinkles.
Wrinkle fillers offer immediate, yet temporary, reductions of the appearance of lines.
Side-effects depend upon which filler is used. They may include redness, swelling, tenderness and visible lumps. It should be noted, however, that these effects are usually temporary, most only lasting two to three hours or occasionally up to a couple of days. Bruising if it occurs may last up to a week or more. On rare occasions, more serious side effects may occur involving allergic reactions, longer-term lumps or soft tissue damage.
There is little recovery period required with this procedure and most people experience pleasing results if treated by a suitably experienced dermatologist who is able to choose the appropriate filler.