Master Techniques to Treat Eye Issues

Dermatology Times, Dermatology Times, May 2021 (Vol. 42, No. 5), Volume 42, Issue 5

In this month's Cosmetic Conundrums column, Chief Medical Editor of Dermatology Times®, Zoe Diana Draelos, MD, answers a few common questions on how to treat eye issues.

Q: What is the most effective way to camouflage undereye pigmentation?

Lightening agents, such as those containing hydroquinone, vitamin C, or retinoids, are difficult to use around the eye because of the skin’s thinness and increased sensitivity. Products such as these can actually worsen undereye pigmentation by producing irritation that causes postinflammatory hyperpigmentation. I have not found skin-lightening agents to be particularly helpful for undereye pigmentation because, due to pigmentary incontinence, much of the melanin appears to be deep in the dermis. However, protecting against sun exposure by using stick and roll-on sunscreens or wearing sunglasses may prevent further darkening.

Facial cosmetics offer the best way to achieve both sun protection and camouflage. Designed to cover pigmentation problems, undereye camouflage products look like foundation but have a higher pigment load to completely obscure the underlying skin. 

It is best to select a waterproof camouflage product line with an extensive color range so that skin tone can be matched exactly in terms of pink-yellow balance, cool versus warm tones, and actual skin color. Selecting a product that is 1 or 2 shades lighter than the surrounding skin will lighten the periorbital area. Camouflage products developed for the theater (eg, MAC Cosmetics Studio Fix 24-Hour Smooth Wear Concealer) seem to perform better, in my experience.

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

Q: How can undereye edema, which creates undereye bags, be minimized?

Undereye camouflage cosmetics can decrease bag appearance, but cannot eliminate it. In my view, undereye bags and edema are very difficult to treat and tend to be genetic.

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

Some undereye edema may be due to inhaled allergies. In my experience, some patients respond nicely to a nonsedating antihistamine taken once daily. These individuals typically notice worsening of undereye bags in spring and fall when their allergies are most problematic. It might be worthwhile for some patients to consider a 2-week trial of a nonsedating antihistamine to see if improvement is achieved.

Q: Do facials provide any undereye benefits?

Many patients ask if professional facials or other devices can improve undereye appearance. Massage might remove extracellular fluid temporarily, but any effect is short term. It is also difficult to massage the eye area. It’s better to elevate the head while sleeping.

A variety of undereye patches are designed to minimize bags. Many are gel patches that contain ingredients such as caffeine, which is designed to have vasoactive effects. I have not found these patches helpful. In some cases, undereye bags worsen due to occlusion of the skin and overhydration of the tissue, which actually increase the appearance of bags.

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