The face is the part of the body in which signs of ageing are first noticed. Early signs of facial ageing occur primarily around the eye and midface.
Over time, supporting ligaments around the eye increase in laxity causing sagging of the brow. The lower eyelid margin starts to migrate downward. By the fourth decade of life, fine wrinkling gradually becomes more apparent and pigmentation changes occur. These changes are due to thinning of skin layers, decrease in collagen synthesis, and deterioration of collagen and elastin molecules. There is a loss and redistribution of fat with age that leads to the uncovering of blood vessels underneath the eye. This can be seen as a bluish or dark purple hue in the periocular area, commonly referred to as dark circles. Hollowing and loss of volume underneath the eyes causes a shadowing, and accentuation of the outline of the orbital rim of the bony eye socket. Facial bones become thinner and start to resorb with age, causing the eye socket to enlarge, further contributing to a sunken eye appearance.
Thinning of the skin around the eye can be treated with Ultherapy® to tighten and stimulate new collagen formation in conjunction with topical daily medications that can boost and maintain collagen synthesis and diminish fine lines.
Discoloration under the eyes may be due to hyperpigmentation which can be treated with topical lightening agents. Hollowing due to loss of tissue volume can cause shadowing, which can make the undereye area appear darker. Injecting small amounts of hyaluronic acid gel or platelet rich plasma to correct volume loss in this area can be of benefit. Neuromodulator injections to select for an increase in the muscles that lift the brow and minimize wrinkling around the eye can improve ageing changes.