Bright eyes for the new year: Rejuvenate your look

Many people look for ways to refresh their appearance as the new year begins, and the delicate undereye area is often a focal point. The lower eyelids are among the first areas to show signs of fatigue, aging and volume loss, especially after the hustle and bustle of the holiday season. Dark circles, hollowing, fine lines and crepey skin can become more pronounced due to genetics, stress, dehydration or natural collagen loss. Even subtle changes can make someone look tired or older than they feel because this area is so expressive and central to how we communicate.

Today, nonsurgical eye rejuvenation is more advanced and accessible than ever, offering patients meaningful improvements without the downtime of traditional surgery. Options like injectable fillers, skin-tightening lasers, radiofrequency microneedling and chemical peels can brighten, smooth and restore volume with increasingly precise results. For patients seeking longer-lasting or more dramatic results, surgical techniques, such as lower blepharoplasty, remain the gold standard. Together, these treatments give individuals the flexibility to choose an approach that matches their goals, lifestyle and comfort level as they head into the new year with a refreshed, confident appearance.

To learn more about options for lower eye rejuvenation, we reached out to ASPS Member Surgeons John Burns, MD, and Karen Horton, MD, MSc, FACS, as well as aesthetic nurse practitioners Laura Stelk, DNP, APRN, FNP-C, and Agnes Wong, MSN, NP-BC.

Contributing factors to changes in undereye appearance

Changes in the appearance of the undereye area can be due to a variety of factors, including genetics, lifestyle and environmental influences.

"When looking at aging in the face, the eyelids are one of the first places that you will start to see changes, specifically the laugh lines," said Dr. Burns. "In the lower eyelid, the layers within will begin to weaken and be affected by gravity, causing the fat underneath to project, giving the appearance of what we call a 'bag.' With older patients, you will start to see a tear trough, or a slight separation with a clear line between the lower eyelid and the cheek."

In addition to the natural changes in the skin that occur with aging, other factors can contribute to a tired-looking undereye area.

"Lifestyle and environmental influences can further worsen the look of fatigue, such as sleep deprivation, dehydration, allergies, sun exposure, smoking and chronic eye rubbing," said Wong.

Certain settings can make bags, fine lines and dark circles look more pronounced.

"Most patients who present with complaints of dark circles under the eyes have had them for years; they are just noticing them more with aging and spending so much time on Zoom," said Dr. Horton. "Lighting also can make them look worse than they actually are. Good lighting and makeup can help lessen their appearance day to day."

Innovations in undereye treatment options

The growing focus on the appearance of the undereye has led to an increased prevalence of innovations and technological advancements in treatment options, especially noninvasive options. While nonsurgical options are gaining popularity, there is no denying that the tried-and-true surgical intervention remains the top treatment choice.

"The gold standard for lower eyelid rejuvenation is the surgical approach, also known as a lower blepharoplasty," said Dr. Burns. "With this procedure, you remove some of the fat that is causing the visible bag under the eye or remove loose skin for a tightened appearance."

Other experts echo this point, underscoring that surgery remains the definitive solution for more advanced undereye concerns.

"The gold standard for treating significant fat herniation or excess skin under the eyes remains a surgical lower eyelid blepharoplasty, which can precisely remove or reposition fat and remove loose lower lid skin for long-term results," said Wong.

Surgical intervention may be the preferred treatment, but it may not be right for every patient.

"Not all patients are candidates for surgical blepharoplasty, and it is important to see a board-certified plastic surgeon with extensive experience in similar procedures," said Dr. Horton.

There are many viable minimally invasive options available to interested patients. One popular treatment is the use of undereye injectable fillers to combat hollowness and texture changes around the eye.

"Hyaluronic acid (HA) fillers remain a cornerstone for addressing undereye contour irregularities and restoring lost volume," said Wong. "When performed with the right technique and product selection, fillers can smooth tear troughs, reduce shadowing and create a refreshed, natural-looking appearance. There is also a growing emphasis on full facial harmonization, ensuring that undereye enhancements are balanced with the rest of the face for proportional, harmonious results."

Platelet-rich plasma (PRP) therapy and platelet-derived fibrin (PRF) are additional options.

"These treatments have growth factors in them that work to stimulate new collagen production and reverse the signs of aging in a slow, methodical manner," said Dr. Burns. "PRF is a little more concentrated and effective than PRP, but both are viable options."

Another category of undereye treatments is biostimulators. This treatment is still being actively researched, but offers tremendous promise in the field of skin and undereye rejuvenation.

"Bioregenerative options are the hot thing, and that's where we're seeing the most results for our patients," said Stelk. "We're seeing patients move away from filler, partially due to social media, and towards options like PRP, PRF and PDGF – things that are really stimulating collagen and elastin."

The shift toward regenerative therapies extends beyond platelet-based treatments, with new biostimulatory technologies gaining traction as well.

"Polydeoxyribonucleotide (PDRN), a type of polynucleotide, is emerging as a highly effective tool in regenerative dermatology due to its ability to stimulate cellular regeneration, support tissue repair, promote angiogenesis and reduce inflammation," said Wong. "Clinical studies suggest that PDRN can improve skin elasticity and texture – sometimes even more effectively than traditional hyaluronic acid fillers – and is generally well tolerated. However, it's important to note that PDRN is not yet approved by the U.S. Food and Drug Administration (FDA), as additional research is still needed to fully validate its safety and efficacy."

Another emerging treatment option is platelet-derived growth factor (PDGF).

"You may have also seen Ariessence's pure PDGF (platelet-derived growth factors) being discussed as the next major innovation for undereye rejuvenation," said Wong. "This formulation contains up to 300,000 times more growth factor than many existing aesthetic products and shows early promise in stimulating angiogenesis and cellular proliferation to rejuvenate the periorbital region."

While this treatment is certainly promising, it's important to keep in mind that it has not yet been approved for injection by the FDA and is currently undergoing further research.

"This is the major controversy right now," said Dr. Burns. "PDGF is only supposed to be used topically, but some providers are injecting it, going beyond what we would normally consider off-label use. This application is still undergoing evaluation with the FDA, and you do see arguments on either side as to how effective this really is."

With a range of effective nonsurgical and surgical options available, rejuvenating the undereye area has never been more customizable or patient-friendly. Whether someone is after subtle brightening, looking to restore volume, seeking a smoother texture or all in for a more comprehensive surgical enhancement, board-certified plastic surgeons can help them choose a path that aligns with their goals. As techniques continue to evolve and become even more refined, patients can look forward to safe, natural-looking rejuvenation that starts the new year on a brighter note.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.