Ask the Dermatologist: ‘I’m 43, my eyes are tired and crepey, what’s the best treatments and eye cream for me to use?’

Skincare 

Keep skincare basic. Use a gentle hydrating cream cleanser morning and evening (I love CeraVe Hydrating Cleanser, €10.40) combined with an oil-in-gel cleanser in the evening (my favourite is Elta MD Oil-in-Gel Cleanser, €44) to double cleanse and remove makeup, pollution and impurities. The cornerstones of a scientifically based skincare regimen are using a zinc SPF in the morning and a retinoid at night – it is incredible how many patients leave the eye area out with these agents when it is skin that needs these products the most! The delicate thin skin of the eye is so susceptible to UV damage which greatly accelerates the breakdown of collagen resulting in crepey, lax skin. My favourite is Elta MD AOX Eye SPF, €67 – this is an eye-specific 100% mineral SPF enriched with a powerful mix of skin-rejuvenating peptides, hyaluronic acid, antioxidants, and anti-inflammatory ingredients to minimise fine lines, decrease swelling, brighten dark circles and strengthen the skin barrier. Retinoids are the most potent collagen-inducing topical agents, and nowhere needs collagen more than the delicate thin periocular skin. Use your usual retinoid on your undereye and crow’s feet area, followed by a good ceramide and hyaluronic acid-containing moisturiser (Elta MD Barrier Renewal Complex , €82 or Skingredients Good Fats Ultra-Hydrating Ceramide Moisturiser, €55). Skinbetter Science EyeMax AlphaRet Overnight Cream, €135 is an excellent choice for those with more sensitive skin – this is a retinoid that is combined with antioxidants, hyaluronic acid and hydrating ingredients to optimise the skin around the eyes. 

Nourish yourself from the outside in! A healthy, well-balanced diet, enriched in protein and antioxidants improves skin health. Oral hydrolysed collagen has been shown in the most robust meta-analyses to improve skin hydration, decrease fine lines and improve skin elasticity, particularly in periocular skin – aim for 8g of collagen, preferably marine. Omega 3 fatty acids also improve skin hydration and elasticity.  

Sleep hygiene makes a great difference to the appearance of the periocular skin. We regenerate our tissues overnight so getting adequate sleep is key. Sleep on your back! Sleeping on either side of your face means that the skin, dermis and supporting deep tissues (subcutaneous fat and bone) are compressed by your body weight for six to eight hours every night. This produces sleep lines and swelling, but more importantly, causes significant volume loss over time. Sleeping on your back is free and will save you a fortune in treatments!  If you can’t, use the Sleep and Glow Aula Pillow, €209 available in our online shop.

After these cornerstones of anti-ageing skincare, save the money you would usually spend on fancy eye creams for cosmetic procedures that will target specific eye concerns. 

Polynucleotides

My absolute favourite solution to crepey undereye skin is now PhilArt Eye polynucleotides. Polynucleotide treatments have become incredibly popular for their effectiveness in facial rejuvenation with minimal downtime. Polynucleotides, natural DNA polymers, are advanced bio-stimulating agents that promote fibroblast activity, collagen and elastin production, to help improve the texture and tone of the skin, and to help promote overall skin rejuvenation. PhilArt Eye, a concentrated polynucleotide treatment that focuses on rejuvenation around the eyes, revitalises the skin around the eyes, improving the appearance of fine lines, wrinkles, and dark circles. Polynucleotides stimulate the production of collagen and elastin, strengthening skin elasticity, which can help reduce the appearance of eye bags and droopy eyelids. They also provide intense and long-lasting hydration to the skin, making it look fresher and more radiant. Signs of fatigue are reduced, and the vitality of the eye area is restored. With their anti-inflammatory properties, polynucleotides can reduce swelling around the eyes and have a soothing effect. The skin is rejuvenated and rehydrated and wrinkles are reduced. Typically three treatments are needed two to four weeks apart (a course of three costs €1,000 at our Cosmetic Suite). 

Anti-wrinkle injections

Botulinum toxin (botox) injections smooth crow’s feet and can help lift sagging brows to open the eyes and produce a younger, more refreshed appearance. Be careful though as botox injections relax the muscles around the lateral eye (crow’s feet) and can paradoxically worsen the appearance of the undereye area, including puffiness and crepey lines. 

Dermal fillers

For those with hollowing under the eyes, “tear trough” hyaluronic acid fillers have become very popular. Hyaluronic acid is a naturally occurring substance and an essential component of our facial tissues which declines over time. This non-surgical volume enhancement plumps the undereye area and can dramatically improve the appearance of the undereye area for the appropriate patient who has suffered from volume loss. Choose your injector wisely – when tear troughs are filled incorrectly or overfilled, it can result in a very strange “Miss Piggy” look! Tear trough fillers typically should not be performed in isolation without filling the lateral cheek area to maintain the best aesthetic ratios.

Secret Pro Eyes: Combination Co2 fractional ablation and radiofrequency microneedling 

The combination of Co2 fractional ablation resurfacing and radiofrequency microneedling is the ultimate treatment for those with skin laxity and crepey skin around the eyes. It has absolutely transformed my eyes!  CO2 resurfacing and radiofrequency energy hyperstimulate collagen production in the skin, which can help diminish the appearance of fine lines and wrinkles around the eyes. The heat generated by the RF treatment in the deeper layer of the skin promotes tightening of the skin and improves its overall texture. This can be particularly beneficial for addressing sagging skin around the eyes, such as droopy eyelids or under-eye bags.

RF and Co2 treatments can help reduce puffiness and under-eye bags by encouraging lymphatic drainage and reducing fluid retention. The heat generated by the RF energy can also improve circulation in the area, which can further alleviate puffiness.

Although RF and Co2 treatments are not specifically designed to address dark circles, the stimulation of collagen production and improved skin texture can contribute to an overall improvement in the appearance of dark circles. This is an incredible rejuvenating treatment but it comes with the price of downtime – typically patients experience significant swelling and flaking for approximately five to seven days, so it needs to be well timed. Choose a bank holiday weekend or a time that you have no social events! 

Surgery

There are some patients with very marked skin laxity of the upper or lower eyelids in whom upper and/or lower lid blepharoplasty is necessary. This surgery can be a game-changer for some. This shouldn’t be done in isolation – surgery removes excess skin but does not improve the skin thickness or texture so the basics of skincare are still necessary and pre- or post-treatment  CO2 laser resurfacing will dramatically improve the end result.