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How are YOUR eyes aging?

Many a quotation has been written throughout history about the eyes. They indicate a wide range of expression without saying a word, and have been oft deemed the window to ones soul. Ralph Waldo Emerson is quoted with “The eyes indicate the antiquity of the soul.” As an Aesthetic Nurse Practitioner, I would have continued that thought with “Let us not have eyes that appear older than their time.” One area of the face that many patients, both young and older, want to improve the appearance of is their eyes. This is not a concern only facing my more “mature” patients- people of all ages want their eyes to look good! If a patient is a surgical candidate, I will refer them to my colleague, Dr. Karen Horton, for a surgical consultation. If they are looking for something more subtle, with less “downtime”, or less expensive than surgery, I have some great options for them. LATISSE for eyelash lengthening: Latisse, when applied nightly to the eyelid, will make your eyelashes grow longer, thicker, and often darker. It takes about 8 weeks of nightly use to begin to see results, and 16 weeks for best results. If you stop using the product, eventually your eyelashes will go back to their original length. Occasionally patients complain of eye itching, redness, or irritation as a side effect. If this occurs, you should contact the healthcare provider who prescribed Latisse for you. I will generally recommend that they stop the product until the irritation resolves, and possibly use only every other night if this is an ongoing problem. While this is not a FDA approved indication, and to my knowledge has not been formally tested, I know of a number of Latisse users who have also reported good results using Latisse to fill in over-tweezed or scant eyebrows! Neuromodulators (Botox/Dysport) to reduce “Crow’s Feet”: Lines that form around the outer part of the eyes are commonly referred to as “crow’s feet”, because of the way the circular muscles contract to form 3 primary lines, resembling…a crow’s foot. Not what we want on our faces, right?? It requires at least three injections on the outside of each eye to adequately treat this area. This treatment helps the muscles around the eyes to relax and stop formation of the lines that occur with smiling or squinting. Neuromodulators (Botox or Dysport) generally last about 3-4 months, so this is something that will require repeated treatments to maintain the results. This area of the face is considered “off-label”, as it has not been FDA approved for this area of the face, but if done by an experienced clinician, it can be done safely and with great results. While this can provide great results by relaxing the muscles around the eye, it doesn’t do anything for the skin itself. So if you have aging or sun damaged skin, to get optimal results you also need to take care of the skin that is overlying the muscles in this area, which involves daily sunscreen and a quality, medical-grade eye cream. Filler in the tear troughs: Many people notice a dark area under their eyes that does not disappear with makeup. This dark shadow can occur because of a “hollowing” of the tear trough area that is related to fat volume loss in the mid-face (a normal process that occurs with aging). Another factor that contributes to this is because the skin is so thin in this area, the blood in the vessels under the eyes can be visible and seen as a “dark shadow” under the eyes. If the only issue is hollowing, an injectable dermal filler may fully correct this problem. If the issue is thin skin and visible blood vessels, a treatment with filler may help to reduce the shadow, but the darker skin is something that will not resolve only with filler. It is important that you see an experienced and trustworthy clinician for this treatment, as if your issue is dark skin and not “hollows” of the tear troughs, you may end up disappointed with the outcome of the treatment because you may still have dark circles under the eyes. Choosing the right filler to use in this area of the face is also extremely important (Restylane is my filler of choice for the tear troughs). I give all my patients an honest assessment, and I inform them whether I think filler in the tear troughs is an appropriate treatment for them. I also inform my patients that while I have extensive experience with this procedure, injecting dermal filler to the tear troughs is considered “off-label”, as is not an FDA-approved indication. The tear trough area under the eyes is very sensitive, with very thin skin and many blood vessels. It takes a skilled practitioner with a steady hand, and artistic eye, and a thorough knowledge of the anatomy to create a natural look in this area of the face. If done too superficially, the area can actually have a blue tinge to it, called the Tyndall effect, because of the scattering of light off the filler particles. If too much is injected, you can look like you have “bags” or puffiness under the eyes. If done in an incorrect area, the injector can hit the optic nerve or a blood vessel, which can cause bruising and potentially serious complications, including tissue necrosis (are you still sure you want to go bargain-hunting for your filler treatment??). This information is not intended to scare patients away from the procedure, but rather to be fully informed about the risks and benefits of any treatment, and the importance of choosing the right clinician for your treatment. When done correctly, patients are very pleased with the smooth, natural appearance under their eyes, which will make them appear “rested”, not “overdone”. If you are interested in any of these treatments, or would like to discuss your options for non-surgical facial rejuvenation, please call our office for an appointment.   Wishing you happiness and health, Courtney McSpadden, Aesthetic Nurse Practitioner



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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA