Boston Cosmetic
Boston Cosmetic

















Boston Cosmetic


Eyes are a hugely expressive part of your face—they crinkle when you laugh and squint when you’re stressed—but all of those emotions take a toll on the delicate skin around your eyes. The wear and tear of constant movement leads to fine lines and wrinkles. One of the first places where visible signs of aging begin to emerge is around your eyes. The delicate skin in this area is extremely thin—becoming even thinner as you age—and is especially vulnerable to unsightly age-related changes in appearance, including dark circles, “crow’s feet,” and bags or swelling under or around the eyes.

Our patients often complain about the appearance of their eyes. Eyelid skin can be one of the first areas to show aging. Many factors can contribute to the quality of your skin around your eyes including pigment, elasticity, and thickness but fat, bone, and muscle can play a huge role as well. When I evaluate my patients, I look at the quality of their skin, the way their muscles contract when smiling or squinting, and how their underlying bone and fat are doing at supporting an attractive, youthful appearance. Any person at any age may have one or more issues contributing, so I tailor my approach based on the individual.

The top 4 complaints about the eyes, and how we can address those complaints.



1. Dark Circles

Dark circles are most often hereditary, although they can be accentuated with allergies or exhaustion. There are many causes of dark circles so there is no one size fits all approach.

Various causes of Dark Circles include:

  • Loss of Fat and Bone: Shadows and hollows from underlying volume loss create a concavity, often called a tear tough. Shadows form in this hollow, resulting in a dark appearance


  • Loss of Collagen: Thinned, translucent skin allows bluish veins to become more visible.Replace volume loss with fillers in the tear trough and under eye area.


  • Congestion of Blood Vessels: From allergies and stomach sleeping


  • True Hyperpigmentation: Darkening of the skin itself can be part of the natural aging process, especially in darker skinned individuals. Rubbing your eyes chronically can also darken the skin.


How can I treat Dark Circles? It depends on the cause! Here are some of our suggestions:

        • Keep your head elevated to prevent vascular congestion and don’t stomach sleep.
        • Try a Zyrtec or another antihistamine if allergies are the culprit.
        • Thicken your collagen with topical treatments: Retinoids and growth factors are you best choices.
        • Use a retinoid like tretinoin(our Green Gel is a great one) 1-2 times a week on upper and lower eyelids, this can help thicken the skin and make dark circles less visible. Many of our patients have the misconception that they cannot use a retinoids around the eyes. While this sensitive skin may be less tolerant and more easily irritated, the benefits of a retinoid on this thinner skin are fantastic and can be seen within weeks. Talk to our aestheticians for tips on using retinoids around your eyes.
        • Neocutis Lumiere is a fantastic eye cream that contains epidermal growth factors. These proteins stimulate collagenesis to thicken skin. Lumiere also contains a caffeine derivative to decrease puffiness.
        • Thicken your collagen with Fraxel Re:Store treatments. 4 series of 3-5 treatments will stimulate collagen growth and help to tighten sagging skin.
        • fraxel-under-eye1-1024x211
        • Fade true hyperpigmentation with a Skin Lightening Cream containing Kojic Acid or Hydroquinone.


2.  Wrinkling and sagging. Again, several components contribute. Botox stops you from creating creases, but once a crease has formed, you may have to address underlying volume loss or discuss a skin resurfacing cream or laser.

  • Thinning Skin: As you age, collagen breakdown exceeds collagen production resulting in a thinner epidermis. Your dermis gives support and thickness to your skin, so when it thins, skin becomes crinkly and fine lines become visible.

  • Loss of Elasticity: Elastin production slows as well. Your eyelids lose elasticity and start to droop.

  • Dynamic Creases: Repetitive movements like squinting cause creases (crow’s feet) in the skin’s top layer, the epidermis.

  • Folds from Loss of Volume: Loss of fat and bone takes away underlying support and results in sagging skin and hollows.


How can I treat wrinkling and sagging skin?

  • Thicken your collagen with Fraxel Re:Store and / or Ultherapy treatments. Generally a series of 3-5 treatments will sufficiently stimulate collagen growth and result in marked tightening of sagging skin and


  • Botox stops the habitual creasing of the skin, ultimately stopping the wrinkles from forming or getting deeper.


  • Replace volume with fillers. We often see patients with crow’s feet around their eyes that are really tissue folds from loss of fat and bone. They complain that botox has never worked. This picture is a great example, when she is smiling she accentuates the crow’s feet, botox will help soften that movement and prevent wrinkles from getting deeper. When her face is relaxed in the lower picture, she still has wrinkles. This is due to volume loss, we recommend injectable filler in the brow bone and temple to lift the skin and reduce the appearance of saggy skin.


  • As above, thicken your collagen with topical treatments: Retinoids and growth factors.

3. Hollowness/Puffiness

Fat pads that should reside beneath your eye, supporting it, migrate downward. This happens because the thin membrane that holds the fat pad weakens with age and the bone surrounding the eye begins to diminish, leading to bigger eye hollows.


How can I treat Hollowness/Puffiness?

  • Filler and Fat will help reduce under eye hollows and can also make the brow bone appear lifted and youthful.


  • You may need a blepharoplasty to eliminate excess skin and reposition fat pads.

4. Lashes

  • Your eye lashes get shorter, thinner, and sparser as you age.

How can I treat aging lashes?

  • Latisse makes your natural lashes longer, darker, and fuller. Studies have shown that having long lush eyelashes makes your eyes look younger.



The one, one-sized fits all recommendation here: The sooner you start protecting your eyes the better!

  • Wear Sunscreen EVERYDAY.
  • Always wear large, 100 % UV protected sunglasses to keep you from squinting in bright light and to screen damaging UV rays.

Eyelid rejuvenation is complicated and requires experience and expertise so contact Boston Cosmetic Specialists for a detailed, complementary consultation with Dr. Edwin Ishoo to discuss all your options.  The good news is this thin skin and  muscle responds beautifully to small amounts of products, injectables, Ultherapy or lasers and in more severe cases blepharoplasty is the definitive treatment.  With a problem-targeted plan you will get control of your issues in no time.