Hi. I'm only 22. After an assault, I had a very stressful 2 years that I feel have aged me. I’m happily in the next chapter of my life, but the telltale signs of the previous are still around my eyes. (see pictures and captions) I’m tired of being told I look tired and worn out all the time when I certainly don’t feel that way. I’m just curious what products or options (preferably more long term) are available in fixing some of this and preventing more from developing. Thanks for your guidance
Early 20s with Loss of Resiliency and Wrinkling Under Eyes. Solutions? (photo)
Doctor Answers (10)
Hollowness and crepiness
There are two minor [and they are minor!] issues that can be addressed. The fine lines/crepiness around the lower eyelid can be addressed with Erbium/CO2 combination laser. This is safer than pure CO2, though fractional laser has improved safety in this regard.
There is also a mild hollowing along your lid/cheek junction that makes your eyelid fat more apparent. Fillers such as Restylane or Juvederm would be ideal in this area.
Wrinkling and hollowness in the lower eyelids can be treated with laser resurfacing and dermal filler
At 22 years old, I wouldn't recommend pursuing lower eyelid surgery. Fractional laser resurfacing can help with the crepey changes in the lower eyelid skin. The hollowing below your lower eyelid can also be filled with a hyaluronic acid filler such as Restylane. It is quite possible that you would benefit from a lower blepharoplasty down the road but the tear trough and skin redundancy that concern you aren't significant enough at this time to consider surgery.
Thank you for your question.
Stephen Weber MD, FACS
Loose skin of the lower eyelids
There are two solutions to your problem of loose skin of the lower eyelids. Consider microablative CO2 laser treatmetn such as SmartSkin or use a vitamin A product such as Retin-A. You would need to start with a low dose of Retin-A .05% and it will take about 24 weeks to see some degree of improvement. If you want to use the laser then you should be off of Retin-A for a month prior to the treatment.
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Lower lid wrinkling and hollowing treatment
Your photos seem to indicate hollowing of the lower eyelid area which causes dark shadowing. Your fine wrinkles may be from years of squinting, relative redundancy of skin. I suggest to start with because of your young age doing some simple things that would help a lot.
At 22 years of age - My recommendation would be to be evaluated for fillers such as jeuvederm, restylane or other HA filler. Radiesse would also work. This would take care of the hollowing and in filling out the depressed "tear trough" area might even help some of the wrinkles. If not consider a TCA or other light peel or light laser treatment of the lower lids. Light color base make-up might also help as would be moisturizers as a finishing touch.
Part of the answer depends on the appearance you are trying to achieve. There appears to be a slight protrusion of the inner fat pad and the inner bony margin of your eyesocket is visible (tear trough). One approach would be to remove or reposition the fat pad through an inner eyelid incision (transconjunctival approach) and release the attachments causing the tear troughs.
A second possiblity is to camouflage the fat pad and tear trough with some type of filler. A temporary solution using Restylane or Juvederm will give you an idea of the look. If you don't like it, it will disappear. If you like it, a permanent solution would be fat grafts.
A third approach is a combination of the operation and fillers.
Premature aging of lower eyelids
I'm sorry that you have had such unfortunate events at your young age. The lower lids are very delicate and may be reflecting some of that stress, however more likely causes are a genetic predisposition and or allergies. Of course it goes without saying to get plenty of sleep and stay hydrated. Sleep with your head a little elevated. Try a retinol product or Renova at the cheek lid juncture to help firm up the eyelids. Use a good eye cream and a lightweight concealer if desired. After that, the tiniest bit of Juvederm in the "circle" can be helpful. Another option would be a light TCA chemical peel to retexturize and tighten up the lower lids. Ultimately a very conservative lower lid blepharoplasty to remove the protruding fat pad can recontour the eye area.
Lower eye lids
This may just be your genetic make-up. An exam would be helpful to evaluate you. Sometimes camouflaging of the owoer lid region can be beneficial. But again an exam is essential.
Lower eyelid surgery is the best solution for sagging lower lids, but sometimes filler can camouflage the problem.
At 22, I would guess that the fullness of your lids is more a familial problem than aging. Fillers can be used to camouflage the contour changes. Lower eyelid surgery would be a permanent solution to the problem with a very predictable good result in a patient like you.
You may benefit from some Restylane or Juvederm in the hollow tear trough and some laser lightening/tightening of the skin.
It not appear that you need eyelid surgery. Possibly you would benefit from some Restylane or Juvederm filler in your tear troughs and possibly some laser tightening and/or lightening.