In the eye of the beholder: aesthetic procedures for the periocular area: do you know how to talk to your patients about this important, but often overlooked, area?
Optometrists are well versed in recognizing functional concerns and managing ocular disease treatment, yet many do not consider the various dermatological options and surgical procedures available for aesthetic enhancement of the eyes--and many patients, while curious, many not know how to ask.
When discussing aesthetics around the eyes, says Wendy Lee, MD, an oculoplastics surgeon at Bascom Palmer Eye Institute in Miami, it's important to first remember the anatomy of the periocular area and why it is vulnerable to aging. Periorbital skin is the thinnest on the body and contains lower numbers of sebaceous glands than other areas. These glands produce sebum to lubricate and waterproof the skin; with fewer glands, periorbital skin tends to dry out and wrinkle faster. A lack of subcutaneous tissues beneath the thin eyelid skin means the skin tightly adheres to the underlying muscles, which are constantly contracting and transmitting movement to the delicate tissue.
As we age, our skin becomes thinner and loses its elasticity as a result of slower production of the proteins collagen and elastin, which impacts the skin's ability to repair itself and hold its shape. (1) Age also affects bone, tendon and muscle mass, which can alter the shape of the periorbital area.
The reason we notice signs of aging around the eyes faster, says Dr. Lee, is because the eyes are the aesthetic center of the face. It is typically the area we focus on when we're talking and listening to other people, so any irregularities or blemishes are noticed more quickly than if they were present on other parts of the body. For this reason, many patients are concerned with making sure their eyes and surrounding skin look as symmetrical, youthful and healthy as possible.
Hydrate and Protect
The most basic education optometrists can provide to their patients is on preventative care, namely: hydrate and protect. When it comes to hydration, "anyone who has dryness in the eyelids will notice more accentuation of fine lines and creases," says Hilary Johnson, MD, clinical assistant professor of dermatology at the University of Iowa Carver College of Medicine. Most facial creams contain a hydrating agent, but it's important to select one designed specifically for eyelid use to avoid complications.
Adequate sun protection is a must as well. "It's hard for us to think of the eyelids as one of those places to include sunblock, but we see a lot of skin cancer in the eyelid in older folks so it's not a bad idea. From a cosmetic point of view, a lot of our signs of aging, including the skin around the eyelid, is related to exposure from ultraviolet light from the sun," Dr. Johnson says. Patients should remember to apply a stick sunblock around the eyes, which she says is easy to apply and won't drip in the eyes.
Kimberly Cockerham, MD, an ophthalmologist in Stockton, Calif., agrees with Dr. Johnson that sun protection is key, and points out that powdered micronized zinc oxide and titanium oxide are other good...