What are the recommended treatments for anti-aging eye care?

Anti-Aging Eye Treatment Recommendations

For periorbital aging concerns including wrinkles, dark circles, and skin texture changes, platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) injections combined with topical retinoid therapy represent the most evidence-based approach, with PRF showing superior outcomes for canthal smoothness compared to PRP alone. 1, 2

Primary Treatment Approach

Injectable Therapies (First-Line for Moderate to Severe Changes)

Platelet-Rich Fibrin (PRF) is the preferred injectable option over traditional PRP for periorbital rejuvenation, demonstrating superior results specifically for canthal smoothness and wrinkles at 3 months. 2

Treatment Protocol:

• Three treatment sessions spaced at minimum 21-day intervals 3, 2
• Maintenance treatment every 6 months following initial course 3, 2
• Use 30-gauge needles for injection or 0.25mm depth for microneedling application 2
• For enhanced safety in the delicate under-eye area, use a 22G × 2 inches cannula when using Alb-PRF formulation 2

Expected Outcomes:

• Improvements in periocular wrinkles, periorbital hyperpigmentation (dark circles), skin thickness, and overall skin freshness 2
• High patient satisfaction rates across multiple studies 1, 2
• Favorable safety profile as an autologous material with minimal side effects 2

Important Caveat: Warn patients about temporary bruising and swelling that typically resolve with time. 2

Topical Retinoid Therapy (Essential Adjunct or Standalone for Mild Changes)

Nightly application of a double-conjugated retinoid/alpha hydroxy acid eye cream (AHARet-EM) is highly effective for periorbital aging. 4

Treatment Protocol:

• Apply nightly to periorbital area 4
• Consider adding morning application of peptide-rich eye cream for enhanced benefits 4
• Results become significant by week 12 4

Expected Outcomes at 12 Weeks:

• 33% improvement in lines/wrinkles 4
• 37% improvement in skin texture 4
• 41% improvement in under-eye darkness 4
• 55% improvement in puffiness 4
• 94% improvement in dryness 4
• Non-irritating formulation suitable for sensitive periorbital skin 4

Alternative and Adjunctive Treatments

Red Light Therapy

Combine red light therapy with PRP/PRF for enhanced results in cutaneous spots, wrinkles, pore reduction, and texture. 3

Protocol:

• Three treatments with minimum 21-day intervals 3
• Maintenance every 6 months 3

Limitation: Primarily addresses fine lines and skin texture rather than deep wrinkles. 3

Chemical Peels

For periorbital hyperpigmentation specifically, chemical peels (trichloroacetic acid 3.75% and lactic acid 15%) may be more effective than PRP, with 38% of patients achieving excellent improvement versus 0% with PRP alone. 1

However, chemical peels carry higher risks in the periorbital area compared to autologous treatments. 1

Medical Management of Underlying Eye Conditions

Age-Related Conditions Affecting Periorbital Appearance

If visual impairment accompanies periorbital aging concerns, address underlying pathology:

Cataracts: Surgical removal with intraocular lens implantation improves visual acuity in approximately 90% of patients. 1

Age-Related Macular Degeneration (AMD):

• Wet AMD: Intravitreal VEGF inhibitor injections are the primary treatment 1
• Dry AMD: Antioxidant vitamins and minerals reduce progression 1

Refractive Errors/Presbyopia: Corrective lenses improve visual acuity. 1

Patient Counseling and Maintenance

Essential recommendations to maximize and maintain results:

• Maintain good home skincare routine 3, 2
• Use adequate sun protection daily 3, 2
• Avoid smoking (major risk factor for AMD and accelerated aging) 1
• Address modifiable risk factors: obesity, diet low in green leafy vegetables, elevated cholesterol 1

Treatment Selection Algorithm

For mild periorbital aging (fine lines, early texture changes):

• Start with nightly retinoid eye cream 4
• Add morning peptide-rich eye cream 4
• Consider red light therapy for additional benefits 3

For moderate to severe periorbital aging (prominent wrinkles, significant dark circles, volume loss):

• PRF injections as primary treatment (3 sessions, 21-day intervals) 2
• Add nightly retinoid eye cream for synergistic effects 4
• Maintenance PRF every 6 months 2

For isolated periorbital hyperpigmentation resistant to other treatments:

• Consider chemical peel as alternative to PRP/PRF 1
• Weigh higher efficacy against increased risk profile 1

Common Pitfalls to Avoid

• Do not use traditional PRP when PRF is available - PRF shows superior outcomes for periorbital rejuvenation 2
• Avoid multifocal lenses in older patients with fall risk, as they may increase fall incidence 1
• Do not skip maintenance treatments - benefits diminish without 6-month maintenance sessions 3, 2
• Avoid aggressive depths with microneedling in periorbital area - use maximum 0.25mm depth 2