The quest for fresher looking eyes features very often on the wishlists of patients who see me for facial rejuvenation. A number will need surgery to correct issues caused by excess skin, significent tissue laxity or migration of soft tissue (such as fat herniation causing eye bags). For others with problems such as rings and dark circles around the eyes, the approach is largely non-surgical and usually involves a combination of treatment modalities.

The average dark circle, if such indeed exists, is caused by a combination of :

• hollowing of the area(volume loss) around the eyes
• thinning of the skin (which allows circulatory congestion to show through)
• hyperpigmentation or darkening of the eyelid skin (commonly seen in Asian patients or patients who habitually rub their eyes because of conditions such as eczema and hay fever).

My approach consists of addressing each element in turn, with the treatments layered upon each other. 

I use a denser dermal filler to replace the bony volume loss in the area. This is done deeply by laying the filler right next to the bone. The 2 fillers I commonly use are Radiesse (calcium hydroxyapatite) or Boletero (hyaluronic acid)

Thickening of the skin around the eyes has been challenging up to recently because injecting fillers superficially into the skin often interrupts the lymphatic drainage, causing prolonged swelling. Restylane Skinboosters are a new range of Hyaluronic Acid fillers which have been formulated to be light enough even for use around the eyes while remaining stable enough to yield lasting results. They are ideal for treating the hollow area in the lower eyelid commonly called the tear trough. They can also be used on other areas of the face, back of hands and decolletage.

Treatment of the skin itself can include a brightening agent if pigmentation is a problem. The Obagi Nuderm system which has as it’s active ingredients hydroquinone and tretinoin is very popular in our clinic.

It goes without saying that after the correction, a tailored programme of skin care is necessary to maintain the result.

Mrs CC Kat is a leading Midlands Consultant Plastic Surgeon specializing in cosmetic and reconstructive surgery. She is a full member of both British Association of Aesthetic Plastic Surgeons (BAAPS) and British Association of Aesthetic , Plastic and Reconstructive Surgeons (BAPRAS) as well as several international aesthetic surgery associations. She worked as a Consultant Plastic Surgeon at the Heart of England NHS Foundation Trust but now runs her private practice, CC Kat Aesthetics – Birmingham Laser, Skin and Cosmetic Surgery Clinic, full time. For more information, visit www.cckat.com or call 08453731818.