As a new year begins, many people look for subtle ways to refresh their appearance. The undereye area is often one of the first places patients notice changes. Dark circles, hollowness, fine lines, and puffiness can make someone look tired, even when they feel well rested.

A recent educational article published by the American Society of Plastic Surgeons (ASPS) explored the growing range of options available for lower eyelid rejuvenation. Dr. Karen Horton, a Board-Certified Plastic Surgeon, contributed insight on why this area changes over time and how patients can approach treatment safely and realistically.

Why the Undereye Area Changes

The lower eyelids are particularly delicate. With age, the structural layers of the eyelid weaken, fat may shift forward creating the appearance of “bags,” and the tear trough can deepen. Collagen loss, genetics, dehydration, allergies, sun exposure, and lifestyle factors can all contribute to a tired appearance.

Dr. Horton notes that lighting and increased time on video calls can also make undereye concerns more noticeable than they once were.

Surgical vs. Nonsurgical Solutions

For patients with significant fat protrusion or excess skin, lower blepharoplasty remains the gold standard. This surgical procedure can remove or reposition fat and tighten loose skin for long-lasting results. However, surgery is not necessary for everyone.

Nonsurgical options continue to evolve and may include:

• Hyaluronic acid fillers to address hollowness and contour irregularities in carefully selected patients
• Neuromodulators (such as Botox® or Dysport®) to soften crow’s feet and, in some cases, subtly elevate the brow, which may help improve the appearance of heavy upper lids
• Mechanical microneedling (such as SkinPen®) to improve skin quality and texture in the crow’s feet area and lower eyelids by stimulating collagen production
• Laser treatments and radiofrequency (RF) devices, which are sometimes discussed for skin tightening and collagen stimulation around the eyes; however, Dr. Horton and her team generally take a conservative approach in this delicate area and do not routinely recommend these treatments for the lower eyelids
• Chemical peels, which may brighten and smooth skin in other areas of the face but are not typically recommended by our practice for the thin, sensitive undereye skin
• Platelet-rich plasma (PRP) or platelet-derived fibrin (PRF) to support gradual collagen stimulation

Emerging regenerative treatments such as polynucleotides (PDRN) and platelet-derived growth factors (PDGF) are also being discussed in aesthetic medicine. However, some of these therapies remain under investigation or are not yet approved for certain uses in the United States.

A Personalized Approach Matters

Not every patient is a candidate for surgery, and not every patient benefits from filler. The key is careful evaluation of anatomy, skin quality, and goals.

As emphasized in the ASPS article, consultation with a Board-Certified Plastic Surgeon ensures that treatment recommendations are grounded in experience and safety. Undereye rejuvenation is highly nuanced, and subtle improvements often produce the most natural-looking results.

With both surgical and nonsurgical advancements available, patients today have more options than ever to brighten and refresh the eye area in a thoughtful, individualized way.