Why the area around the eyes changes with age

Why do the eyes look older early on?

When people look in the mirror, the area around the eyes is often the first thing they notice. It is described as the focal point of the face ^[2] and is considered one of the areas where signs of aging appear early ^[1].

The main causes given are loss of soft-tissue volume and resorption of bone ^[1]. In other words, aging around the eyes is not just a matter of the skin loosening; it goes hand in hand with shrinking of the fat and bone that support the skin from beneath. The degree and combination of these changes differ from person to person, so the eye area can look different even in people of the same age.

Changes around the eyes that come with age

One review listed the age-related changes that appear around the eyes as shown below, and explained that these changes need to be addressed together to restore a youthful look ^[2]. Because one person may have several of these changes at the same time, it is important to identify which one is the main cause.

• Excess eyelid skin (dermatochalasis): upper eyelid skin stretches and hangs down
• Bulging fat (fat herniation): eyelid fat pushes forward and bulges
• Droopy eyelid (blepharoptosis): the upper eyelid itself sits lower
• Drooping brow (brow ptosis): the brow moves down
• Deep tear trough: the groove under the inner part of the eye deepens
• Sagging cheek fat (malar fat pad descent): the fat in the upper cheek moves downward

Why volume, sagging, and skin must be considered together

A review of rejuvenation around the eyes stresses the need to understand that the eyelids, brows, forehead, and midface affect one another ^[3]. It concludes that reversing the signs of aging around the eyes requires correcting volume loss, soft-tissue sagging, and skin changes ^[3].

The same is true of the upper eyelid. The literature notes that the brow and upper eyelid should be viewed as a single aesthetic unit and their aging process understood, and that a suitable plan can be made only by assessing both what is in excess and what is lacking around the eyes ^[5]. If an aging upper eyelid lacks volume, correction that restores that volume may be needed ^[5].

Our understanding of aging around the eyes also continues to change. As new anatomical and tissue (histological) studies reveal how the soft tissues around the eyes change, long-accepted ideas are described as being reexamined ^[4].

The bones and forehead also shape how the eyes look

The look of the eyes is affected not only by the eyelids but also by the bony framework around them. This is also why bone resorption is cited as a cause of aging around the eyes ^[1].

A review of surgery that feminizes the face to match a person's gender identity covered techniques that change the expression of the eyes by contouring the bones of the forehead and around the eye socket, along with brow lifts that raise brows that are poorly positioned or have drooped with age ^[6]. This shows that the forehead, brows, and bone contours are connected to the impression the eyes give.

Treatments are combined to match the cause

Restoring a youthful, refreshed look around the eyes is described as often possible only by combining surgical and nonsurgical treatments ^[2]. There are many surgical and nonsurgical techniques for treating the area around the eyes, but careful attention to the patient's concerns and current anatomy is cited as the key to safe and attractive results ^[3].

Injecting hyaluronic acid filler above and below the eyes is presented as an example of a nonsurgical method, and even then, it is stressed that the anatomy, the type of product to be used, the expected results, and possible side effects and complications must all be considered ^[1]. Which method is right for you should be decided through a detailed examination ^[1].

Good to know before your appointment

The literature notes that it is best to identify any asymmetry between the two sides or droopy eyelid that was present before surgery in advance and have it explained to you ^[5]. Standardized photographs, together with an honest conversation about the results you want and realistic expectations, are emphasized as essential for a good outcome ^[5].

• Which of the changes around your eyes is the most prominent
• Whether volume loss, sagging, or skin changes are the main cause
• Whether your brows, forehead, and midface also need to be assessed
• Whether you have asymmetry or a droopy eyelid before surgery
• The order and risks if surgical and nonsurgical treatments are combined