Eye Procedures

How to Treat Wrinkles and other Eye Concerns

The eyes are usually the first place to show visible signs of aging like fine lines, wrinkles, puffiness and dark circles. One reason is because the skin around the eyelids is the thinnest on the body and most prone to thinning, UV damage, and sagging.

If you’ve ever wondered what causes these changes—and what you can do to restore a more youthful, rested appearance—read on.

How and Why Do Eye Wrinkles Form?

The delicate skin around the eyes is prone to crow’s feet and visible sagging and volume loss, which detract from an otherwise youthful appearance. There are four major causes of eye wrinkles and it’s important to understand them all.


The natural aging process is a primary cause of eye wrinkles because our bodies produce less and less collagen over time—and the collagen that’s still present becomes stiff, brittle and less able to provide structure to the skin. Some studies show that women lose 30% of their collagen in the first five years following menopause, and when this loss is coupled with the effects of gravity, wrinkles, bags and sagging become apparent.


The delicate skin around our eyes is often left unprotected from UV rays, making this area especially susceptible to sun damage. Other environmental factors such as wind, cold weather and pollutants are detrimental to the skin as well, making them another source of wrinkles around the eyes.

Facial Expressions

Repetitive facial expressions such as smiling, squinting and laughing cause our skin to wrinkle in the same place over and over again. Combined with the natural reduction of collagen and the breakdown of elastin as we age, a lifetime of these repeated muscle contractions eventually cause minor wrinkles to become etched into the skin, which makes them visible when the face is at rest.


Excess sun exposure, poor diet, smoking, lack of sleep, and too much alcohol all cause premature aging that negatively affects our skin’s appearance. Smoking is one of the most damaging habits for the skin (and the body as a whole). The nicotine in cigarettes causes the blood vessels closest to the skin to narrow, in turn reducing blood flow to skin. With less oxygen and nutrients available, the skin becomes more likely to develop wrinkles and discoloration.

The Most Common Cosmetic Eyelid Issues


Crow’s feet, or laugh lines, are the fine wrinkles that form around the outer corners of the eyes. These wrinkles continue to deepen over time, but fortunately there are many non-invasive treatment options for this area.


As we age, the muscles and skin around the eyes naturally weaken, which allows the fat that surrounding the eyes to shift position. Fat commonly settles in the lower eyelid area and causes more prominent bags or fat deposits. In some cases, fat loss and atrophy will also cause lower eyelid hollows, also called tear troughs.

Tear Trough

The natural path that tears take is called a tear trough, and with age a deep indentation can become more pronounced between the eyes and nose. This gives the eyes a sunken appearance, creates dark circles and makes the eyes look fatigued even when you are well-rested.

Asian Eyelids

Some people of Asian descent lack a pretarsal fold, which is the natural crease between the eyelid and the brow bone. Also referred to as a “single eyelid,” this can make the eyes appear puffy and tired, and can be easily corrected if needed with oculoplastic surgery.


Asymmetry, or unevenness of the eyelids, can be caused by a variety of factors including birth defects, genetics, aging, head trauma or skin tumors. Malpositioned eyelids can lead to numerous issues and may also impair your vision.

Ptosis/Droopy Eyelids

Ptosis (TOE-sis), or drooping, can occur in both the upper and lower eyelids. This condition can caused by muscle weakness, nerve damage and loose or excess skin. In some cases, severe ptosis may be considered a medical condition and may impair vision.

If you experience any of these issues, Boca Raton oculoplastic surgeon Dr. Steven Fagien can recommend a treatment approach designed specifically for your unique needs and goals.

Treatments and Procedures: How to Get Rid of Eye Wrinkles and Other Issues


Blepharoplasty, or eyelid surgery (and commonly referred to as an eye lift), can be performed on both the upper and lower eyelids. This procedure is used to rejuvenate the eye region by restoring the volume and youthful contours that diminish with age. Blepharoplasty involves reducing excess eyelid skin and/or removing or repositioning fat around the eyes. Upper eyelid blepharoplasty requires one incision across the eyelid (which is undetectable once healed), while transconjunctival blepharoplasty uses incisions inside the eyelid and hence leaves no scars. When performed by an experienced oculoplasti surgeon like Dr. Steven Fagien, blepharoplasty can achieve a soft, well-rested, and more youthful appearance.


Canthoplasty is a surgical technique used to lift the outer corners of the eyes, or provide extra eyelid support after upper or lower blepharoplasty. The goal of this procedure is to reconstruct the weakened or stretched canthal tendon that anchors the lower eyelid. Canthoplasty is ideal for improving a tired or sad expression, revising the unwanted effects of previous eyelids surgery, and restoring a more youthful look to the eye area.

Tear Trough Correction

Tear trough correction requires a customized treatment plan that addresses the unique causes of under-eye depressions or hollows. Treatment can include injectables or surgery, which can be performed at the same time as upper or lower blepharoplasty to minimize recovery time. Dr. Steven Fagien may suggest an injectable filler such as Juvéderm or Restylane that can provide instant and natural-looking results.

Asian Eyelid Surgery

Asian eyelid surgery, or double eyelid surgery, is used to create a pretarsal fold in the eyelid, which is the natural crease between the eyelid and the brow bone. Some people of Asian descent lack this fold, which can give the eyes a puffy, tired look. Double eyelid surgery allows the eyes to open wider, and results in a more alert appearance.


Cosmetic surgery is continually evolving, and injectable fillers and intramuscular injections have become increasingly common, affordable and effective for treating eye wrinkles and other eye-area concerns. Injectables can restore lost volume, improve skin texture and prevent the muscle contractions that cause expression-related wrinkles.

Eye Fillers

Also called dermal fillers, products like Juvéderm and Restylane can offer immediate improvement for wrinkles and tear troughs by filling in depressions and plumping the skin. In addition to these hyaluronic acid-based fillers, there are additional injectable options that may be longer-lasting. Oculoplastic surgeon Dr. Steven Fagien has extensive injectable experience will recommend the ideal filler based on each patient’s unique needs and goals. Fillers are often used in conjunction with surgery to enhance results and provide comprehensive rejuvenation for the entire face. He may also combine filler injections with BOTOX cosmetic injections for an even more rejuvenating outcome.


Products such as BOTOX and Dysport play a large role in eye-area rejuvenation. These injectables relax the muscles that cause expression-related wrinkles and smooth the surface of the skin. BOTOX is the most widely known of these products, but Dysport may be better for some patients since it diffuses more from the injection point and can potentially smooth a larger area. Dr. Steven Fagien is a world renowned expert on the use of neuromodulator or neurotoxins and can suggest the ideal treatment plan to address your individual needs.

Laser Resurfacing

Laser resurfacing is commonly performed in conjunction with surgery and injectable procedures to rejuvenate and tighten skin around the eyes. While surgery and injectables work beneath the skin, laser treatments target the skin’s surface, which plays a major role in a healthy, youthful appearance.

Dr. Steven Fagien’s Expertise in Cosmetic Eye Procedures

If you’re considering surgery or non-invasive treatment to improve the appearance of age-related changes around the eyes, the next step is finding a physician with the expertise and artistic eye necessary for optimal results. Dr. Steven Fagien is one of the world’s foremost oculoplastic surgeons, and he has built his reputation on challenging traditional techniques and developing cutting-edge advances for a variety of procedures. In addition to participating in many of the clinical studies that led to the FDA approval of various injectables, Dr. Fagien has authored over 300 publications, penned his own bestselling textbook on Cosmetic Oculoplastic Surgery, and has given more than 1,000 lectures about his techniques to surgeons around the globe.

To learn more about blepharoplasty and other eyelid procedures, schedule a consultation with Dr. Steven Fagien at 561.393.9898.

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Meet Dr. Fagien

Steven Fagien, MD is one of the world’s foremost experts in oculoplastic surgery, and he has devoted more than 25 years to facial aesthetics.

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