Master the techniques to treat eye problems


Q: What is the most effective way to hide pigmentation under the eyes?

Lightening agents, such as those containing hydroquinone, vitamin C, or retinoids, are difficult to use around the eye due to the thinness of the skin and its increased sensitivity. Products like these can actually worsen pigmentation under the eyes by producing irritation that causes post-inflammatory hyperpigmentation. I have not found skin lightening agents to be particularly useful for pigmentation under the eyes because due to pigment incontinence much of the melanin seems to be deep in the dermis. However, protecting yourself from sun exposure by using stick-and-roll-on sunscreens or wearing sunglasses can prevent further darkening.

Face cosmetics are the best way to achieve both sun protection and camouflage. Designed to cover up pigmentation issues, under-eye camouflage products look like foundation but have a higher pigment load to completely hide the underlying skin.

It is best to select a range of waterproof camouflage products with a wide range of colors so that the skin tone can match exactly in terms of pink-yellow balance, cool vs. warm tones, and actual skin color. Choosing a product 1 or 2 shades lighter than the surrounding skin will lighten the periorbital area. Camouflage products developed for the theater (e.g. MAC Cosmetics Studio Fix 24-Hour Smooth Wear Concealer) seem to work better, in my experience.

Once the appropriate color has been selected, the product should be applied to the skin under the eyes with a sponge-tipped brush and allowed to partially dry. Then a second bushy brush should be used to push the cosmetic into the creases around the underside of the eye. This may need to be repeated several times until the cosmetic has set or dried to prevent the camouflage liquid from migrating into the folds under the eyes. Once attached, the waterproof cosmetic will stay in place until removed. The cosmetic should be removed at bedtime with micellar water.

Q: How can edema under the eyes, which creates bags under the eyes, be minimized?

Camouflage cosmetics under the eyes may decrease the appearance of the bag, but cannot eliminate it. In my opinion, bags under the eyes and edema are very difficult to treat and tend to be genetic.

Some ideas that I use with my patients: The edema under the eyes seems to be worse in the morning after lying flat on the bed. One way to minimize morning edema is to sleep with your head higher than the rest of the body so that the dependent edema has less of an effect on the eye area. This can be accomplished by sleeping on 2 pillows or by purchasing a mechanical bed that elevates the head. Eating less salt can also decrease the volume of extracellular fluid and minimize bags under the eyes.

Some edemas under the eyes may be due to inhaled allergies. In my experience, some patients respond well to a non-sedating antihistamine taken once a day. These people usually notice worsening bags under the eyes in the spring and fall, when their allergies are the most problematic. It may be worthwhile for some patients to consider a 2-week trial with a non-sedating antihistamine to see if improvement is achieved.

Q: Do facials provide benefits under the eyes?

Many patients ask if professional facials or other devices can improve the appearance under the eyes. Massage can temporarily remove extracellular fluid, but any effect is short-term. It is also difficult to massage around the eyes. It is best to lift your head while sleeping.

A variety of patches under the eyes are designed to minimize puffiness. Many are gel patches that contain ingredients such as caffeine, which is designed to have vasoactive effects. I did not find these fixes useful. In some cases, the bags under the eyes worsen due to occlusion of the skin and overhydration of the tissues, which actually increases the appearance of the bags.

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