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The Eyes Have It

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  • Published

    February 20, 2020

  • Written by

    Collins Cosmetic Clinic

The eyes are one of the main facial features that others notice when they meet you. A questionnaire study of 2000 UK adults found the eyes were the body feature that 70% of people noticed first. Not only are the eyes one of the first areas that others notice but they are also regarded by many as a major determinant of attractiveness. A study from the University of York into physical features linked to first impressions of social traits, found that eye shape and the eye area were the most important physical feature when it came to youthfulness and attractiveness.

At the Collins Cosmetic Clinic we have a lot of experience in treating patients concerned about the appearance of their eyes. It is certainly not surprising to us that so many people seek to improve this area, as the eyes are one of the first facial areas to start showing the tell-tale signs of ageing.  As we get older, the skin surrounding our eyes which is already very delicate, becomes even thinner and crepey as the body’s natural collagen and elastin production slows down. This can start to happen from quite a young age as the skin in the eye area is particularly sensitive to the things that cause skin damage such as ultraviolet sun exposure, dehydration and cigarette smoke. With ageing our skin steadily loses elasticity and starts to sag and this can result in hooding of the upper eyelid and bagginess under the lower eyelid. In addition, as we age the supporting fat pads around our eyes progressively shrink, which can cause hollowing especially under the eye.

Shrinkage of supporting fat pads (in yellow) around the eyes with ageing.

When we first see a patient concerned about the appearance of the skin around their eyes we know that a proper medical assessment is essential before any treatment plan is discussed as every face is anatomically and biologically different. Realistic expectations are critical for patient satisfaction as whilst we get fantastic results with our non-surgical treatments around the eye, some patients especially when they are older and have not had any preventative treatments, may have reached the point that surgery might now be needed.

In our many years of experience we have found the 5 commonest concerns that patients have around the eye are

  • Fine Lines under the Eyes
  • Lines on outside of the Eye (Crows feet)
  • Hooding of the Eyebrow
  • Hollowing under the Eyes (Tear Trough)
  • Dark Circles under the Eyes


The skin under the eyes is very thin and fine lines can develop from a young age. These fine lines can be helped by certain eye creams but many expensive commercial eye creams are often no better than a basic moisturiser. Dermal treatments like skin needling can help stimulate collagen and provide significant improvement especially in younger patients. Anti-wrinkle injections are not used as frequently under the eyes but can sometimes help especially in Asian patients who often also want to open up their eyes more. PRP (Platelet Rich Plasma) can give remarkable results in treating fine lines on the face including under the eyes, but not everyone does well with this treatment and patient selection of who is likely to do best is the key.


The area on the outside of the Eye is where lines and wrinkles called “Crow’s Feet” develop. The term ‘Crows feet’ was first used centuries ago because lines in this area were said to resemble the toes of a Crows footprint. It has now become a commonplace term for any lines around the outside of the eye. Crow’s feet develop as part of ageing because of the repeated contraction of the muscles around the eyes but they will develop much more quickly with chronic sun exposure. The sun not only damages the skin’s Collagen, but bright sunlight increases the need to repeatedly contract the outer eye muscles further worsening Crows feet. This explains why in Australia we find Crow’s feet are typically worse on the right side of the face, as this is the side more exposed to the sun when driving. Not surprisingly in places such as the USA, where people drive on the other side of the road, Crow’s feet are usually worse on the left side of the face.

Crow’s feet lines respond exceptionally well to anti-wrinkle injections which can soften or completely remove these lines. Studies show very high patient satisfaction with the treatment of Crow’s feet (over 90%) and the results usually last for 3-4 months. If larger deep lines develop on the outer eye, particularly if present at rest (that is without conscious movement) then other treatments such as dermal fillers or the INFINI can also be needed for the best results.



As we age the eyebrow starts to drop through a combination of increased skin laxity and loss of support and this is called “Hooding”. We find in many cases that the tendency to develop Hooding of the eyes at a young age is genetic and runs in families. Checking out your parent’s faces can often give an indication of what you might be in store for in the future!!

When Hooding first starts to occur the use of anti-wrinkle injections can help lift the brow (non-surgical brow lift). For the best results this is often combined with treating the main frown lines between the eyes to give an even better brow lift. With time in some people Hooding of the eyes can become quite severe to a point it can even effect vision in which case surgery might be required. If surgery is the best option then we can recommend and refer you to a number of plastic surgeons who specialise in this procedure.


Under the eye there is a natural groove which runs from the inside corner of the eye in either a straight or semicircular direction under the eye and we call this the “Tear Trough”. Some young people have a naturally deeper Tear Trough which can result in a shadow effect from the deeper contour contributing to a Dark Circle appearance.  As we age the facial fat pads that support the skin on our face slowly shrink which also contributes to deeper Tear Troughs. Fortunately, the Tear Trough can be corrected with a small amount of Dermal Filler, and the effects can be long lasting for many months if not years. When done correctly this is a very safe and effective procedure but it is very technique dependent and the use of the correct filler is critical to avoid visible lumps. Our experienced injectors have a long history of success in this procedure.


Before Tear Trough Filler                                                After Treatment


Dark Circles under the eye are a common problem and can be very difficult to treat as several different conditions that cause dark circles can be present at the same time. A deep Tear trough can cause a dark circle appearance because of a shadowing effect but also puffiness and congestion under the eyes can cause darkening. The thin skin under the eye can be easily damaged resulting in increased pigmentation and because the skin is thin underlying blood vessels when they get congested become prominent. In our experience the key to getting a good result in treating Dark Circles is in the initial medical assessment to work out exactly what is the cause and/or causes.

For more information on Dark Circles see

Whenever we are giving advice about treating the appearance around the eyes basic skincare advice is still important, the things you can do to help yourself. To slow the ageing effects around our eyes sun protection and a healthy diet and lifestyle are important by which we mean adequate sleep, avoiding smoking, drinking plenty of water for hydration and eating fresh food and vegetables rich in vitamins and healthy oils. Daily use of a moisturiser cream helps maintain skin hydration and special eye creams can have a place in some patients to soften fine lines and/or target dark circles.

The eyes are said to be the “window to the soul and road to your heart” but what do your eyes really convey to other people. Hopefully they do not make you look tired, old or sad. If you have any concerns about the appearance of your eyes or if you simply want to learn what you can do to help prevent your eyes ending up looking like your parents, a consultation with one of our experienced medical staff would be time well spent.

To make an appointment feel free to  contact us for a consultation on 96545720 or

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