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“I’m totally fixated on the bags under my eyes. I always look tired, even if I’m not. I’ve spent a fortune on concealers, but there’s no covering them up anymore. Surgery feels too radical for me, but is there anything else that will help? I don’t really understand how fillers work. Could they work for this?”—Johanna, Toronto
First, it must be said that we are all looking more closely at ourselves than anyone else is, Johanna. But then, for me, this is the point of aesthetic procedures: we do them for ourselves.
I will hand the mic straight to dermatologist Dr. Julia Carroll, of Toronto’s Compass Dermatology clinic, where she does all manner of cosmetic treatments. I love her work: it is subtle and she can really read and work with facial structure. With the non-invasive procedures she does, you don’t get the big “reveal” of plastic surgery, instead you get a slow and steady improvement, until you (blessedly) can’t remember what you were so fixated on before. “There is a reason we take before and after photos,” she says. “Some of the treatments we do take weeks or months to show results. You get used to the changes over time.”
I couldn’t take you in with me, Johanna, so I had Carroll look at my face as a proxy. I’m a few years older, but the under-eye area only really started to bother me recently. “Every face, and every solution is different,” was the first thing out of Carroll’s mouth when I asked her your question. “Treatment is always customized.”
Before we dive into the nitty gritty of what can be done, Carroll explains her approach to assessing a patient’s concerns. “So people come in and ask about bags under their eyes. You observe volume loss or discolouration or thinning skin. Bags under the eyes is the diagnosis,” she says. “But what is the cause? You have to take two steps back; you can’t just treat features in isolation. That’s when people start to look odd.”
“You can’t just treat features in isolation. That’s when people start to look odd.”
If someone goes to their doctor to complain about dizziness, she offers as an example, the doctor doesn’t just give them dizziness pills. She has to figure out why they are dizzy. “It is the same with aesthetic medicine,” Carroll says.
Who is a good candidate for under-eye filler? “Not you,” she tells me. “You need to have a defined volume loss under the eye, with good skin integrity.” Here she shows me the “snap test,” which shows how well the skin bounces back. She is avoiding the word “crepey,” but I see a little creeping crepe under my own eyes.
A good candidate with “classic tear trough volume loss” would receive a “traditional filler of hyaluronic acid gel.” That would be approximately $800. Docs use very little filler these days—Carroll describes a syringe as containing “a fifth of a teaspoon, or one-tenth of a packet of ketchup from McDonald’s.”
In the early days of fillers—the technology goes back to the ’80s, but only went into widespread aesthetics use in the past two decades—“doctors went high volume, filling the face up like a balloon,” Carroll says. This did not look great, and some of my own fear of fillers dates back to the early 2000s and what happened to various celebrities’ faces; you know the ones.
Treatments must also be holistic. Carroll says judicious amounts of filler in what she calls “secret lifting points” on the face will give lift invisibly, and support the undereye treatment. “We’ve evolved a lot. You need to do a bit of natural filling and lifting on the side: temples, cheeks, in front of the ears. This will help improve the lower face, too. If you still have gravity pulling things down, you have an uphill battle.” In other words: if you just focus on the one thing, that is when fillers can make you look weird.
Her rough rule is one dose of filler per decade, plus an extra if you smoke or have sun damage. Remember that one syringe of filler costs about $800. That means that to do a really great job on your undereye bags in a holistic way, you may spend another couple of thousand on fillers and a little Botox here and there. Ladies and gentlemen, I’ve seen the results and it is well worth it, if you can swing the price tag.
But what about my eye bags, which are not good candidates for filler? Carroll says she would do a combination of Ulthera and PRP. Ulthera is a technology that has been around for a while; it is micro-focused ultrasound, designed to tighten skin. It hurts (though there are various pain relief options), and it takes time to show results, but those results last for a long time. Under-eye treatment is about $1,500.
PRP (which stands for platelet-rich plasma treatments) we have spoken about often in Ask the Kit. In this case, Dr. Carroll says she would do two under-eye treatments, eight weeks apart, so two times $800. “I would put in PRP via a cannula, like a filler; and I would also flood the zone with microneedling just below the skin surface.” PRP helps thicken the skin and improve skin tone. It is your own blood spun to remove cells, leaving just the plasma and platelets. “If you injure yourself, the first thing that shows up is platelets that tell your body what to make more of,” she says to explain how it works. In this case, that would be collagen, which help restores the elasticity that was lacking in the “snap” test.
There are lots of other tools in the medical aesthetics toolbox, says Carroll, including Sylfirm, a new RF microneedling tool (she calls it a next-generation Morpheus, for those fluent in radio-frequency aesthetics machines). Lasers can also help with discolouration. “Again, the treatment has to be customized. We have so many options now, but everything isn’t right for everyone.”
We switch over to eye creams. I’m always hoping my problems can be solved with the right jar. “They do help,” she says. “Especially the med-spa options. But please, can you mention how important it is to use sunscreen? It really is the most important anti-aging tool there is.”
Carroll points out two eye serums that she particularly likes; she also shows me before and after photos of herself she took while experimenting with these specific potions during the pandemic. I can see the improvement right there on the doc’s face. One is Neocutis Lumiere Illuminating Eye Cream, which has caffeine to stimulate circulation and ease dark circles. The other is Alastin Restorative Eye Treatment, which takes down puffiness and makes the area look dewier after regular usage. I tried these, and over time—which I normally don’t give to products, because there are so many to try—I, too, am pleased with the results. Sticking with something really does pay off. So does modern aesthetic medicine: it is an investment, to be sure, and the results are subtle. But to me, that is a great thing. No one really wants to look different: we just want to look a little bit fresher, and do a bit better on our snap tests!
Shop the Advice
Specialty eye care does not come cheap! But a little goes a long way
Neocutis Lumière Firm Illuminating & Tightening Eye Cream,$108, compassdermatology.com
This eye cream is available at physicians’ offices, and comes tested and recommended by Dr. Carroll.
Neutrogena Rapid Wrinkle Repair Moisturizer Eye, $30, amazon.ca
At a more accessible price point, this drugstore favourite contains gold-standard retinol to firm and refresh under-eyes.
Alastin Skincare Restorative Eye Treatment, $90, alastin.com
Another Dr. Carroll favourite, here a combination of peptides help to smooth fine lines and take down puffiness.
SkinCeuticals AOX Eye Gel, $109, skinceuticals.ca
Vitamin C and ferulic acid go to work in a refreshing gel formula to brighten and depuff the eye area.
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